Tumgik
#I had my third hour-long appointment with my therapist who I feel genuinely hopeful about and there's still issues I haven't talked about
neverendingford · 22 days
Text
.
#tag talk#I think one of the reasons therapy is so hard is that it's not like I show up and talk about the problem I have.#I show up and have to list all thirty seven problems and explain how their separate and how they're intertwined#I had my third hour-long appointment with my therapist who I feel genuinely hopeful about and there's still issues I haven't talked about#and I get that a lot of these separate issues are really just a basket of extreme symptoms from a few core issues#but it's been so long that they've grown and rooted on their own so it's not just a matter of digging out the original roots. not anymore.#and I do feel like I've made progress. I've made immense progress. the mood stabilizer alone is giving me loads of new data to process.#without it the mood phase I'm in right now would be morose and gloomy with manic energy turned inward to self loathing.#I started that direction a day or so ago because I forgot/didn't care to take my meds and started slipping#but I took my pills and bam I leveled out. and that's nice. I feel calm and serene.#hmm. I've been like this before though. after some sort of emotional high which I did have for a bit.#idk. I'm hopeful I'm positive I'm optimistic but still#I need to talk to my therapist about the feeling like a joke. I'm weird I'm interesting I'm novel I'm strange I know it already.#I'm lonely#I'm tired of being different. of being set apart. of being holy. divine.#I want to be normal. not a spectacle to gawk at or even appreciate. I want to be unremarkable. I want to fit in.#my therapist has enjoyed talking with me. I'm very funny. very charming. tough to keep up with apparently.#those things are intended as compliments but they also just remind me of how alone I am. different. set apart.
0 notes
agustdef · 4 years
Text
With All My Heart
Tumblr media
Pairing: Tattoo Artist!Hoseok x Doctor!Reader.
Genre: Established Relationship; Angst; Fluff
Word Count: 11K
Warning: Angsty. Language...?; Mention of Death; Mentions of mental health struggles
Rating: PG15
Banner Maker: @httpangelicjimin​ who was wonderful enough to remake this one after realized the other wouldn’t work and then proceeded to use it for I Found You.
Beta Reader: @suhdays​ who knew I was in a rush and was kind enough to offer to beta it for me without me asking. 
Tumblr media
When Hoseok came home from his last appointment, he found the apartment mostly silent and way cleaner than when he’d left that morning. Probably cleaner than after the weekly Sunday morning routine was finished, which was impressing and worrisome. But also made him hopeful.
After discarding his shoes and jacket at the door, he headed to the bedroom where he found YN already settled into bed. She wore a large shirt – with the words fight me with a leprechaun on front – that she’d probably stolen from Yoongi’s closet during their last visit, her bonnet, and a koala face mask. Her eyes were focused on the TV on the wall opposite their bed and she hummed along with the intro to the anime she was watching.
It was the most relaxed he’d seen her in weeks.
“Hey baby,” he said.
That drew her attention towards him, and she smiled when they locked eyes, though that stopped as soon as her mask shifted. She was happy to see him and had missed him after the day she’d spent alone. Not that she was lonely or anything, but it felt nice to break away from being by herself.
“Hi. You’re home early. I thought you had to work on that big piece tonight?” she said.
That made Hoseok annoyed in an instant. He huffed and rolled his eyes while his fingers ran through his hair. The memory of the evening he had before, and after he finished what turned into his last client filled his head.
“She called and said she couldn't make it. Which was fine, because I wasn't up to working on it tonight anyway. I'm still feeling sick I guess. But, then she kept changing her mind, and when she finally decided to come - and said she was on her way - she didn't come at all. No response to calls or any of the messages I sent. But I was scrolling through the shop's feed while waiting for my other person only to see her at some other shop we follow getting a different tattoo. I just told her that if she wasn’t going to honor appointments and give me the run around, then we weren’t the right fit.”
In response YN frowned. It was clear how annoyed and tired he was, even without the added stress of a wishy washy, client who just thought they could do whatever the hell they wanted when requesting someone’s time. She wanted to knock the girl upside her head, but it wasn’t realistic, and she’d never go out of her way to attack someone. Though the idea of cussing her out if she appeared at the shop when YN was around didn’t seem too terrible of a plan.
However, that wasn’t something that either of them lingered on long because Hoseok sneezed five times in a row and by the third he seemed wiped out.
YN took off her mask and threw it in the trash near her side of the bed before hopping up. She opened her bedside table and pulled out a thermometer, which she quickly freed from its little bad as she rounded the bed to where he stood. Hoseok knew better than to argue so his mouth opened before she even raised her arm to stick it in.
They stood there for a moment staring at each other, until they heard the beep and when YN looked at the temperature she winced.
“You went up so much since this morning. You’re practically at fever levels. Go take a shower and get in bed. I’ll get some stuff for you to take,” she said.
There was no way Hoseok would argue with how he felt. It was like once he was at home and stopped moving his body had started to give up. He felt heavy and he ached a little here and there. His head also felt a little weird, but he chalked up part of that to being frustrated. So, once she stepped away from him he dragged himself to the bathroom.
By the time he finished his shower and pulled on some clothes, YN was already back in the room. She’d had a bowl, a mug, and a glass of water sitting on the table near his side of the bed. And she was unfolding a blanket, which Hoseok recognized as one the weighted ones. It was something that YN pulled out whenever one of them was having a tough time sleeping or in general, and when they got sick. Something about the thing eased the body into relaxation that neither of them had ever felt before.
When she noticed his arrival, she smiled at him and patted the bed. Hoseok moved as quickly as his body would allow him and plopped down onto the bed. Before he could do much else she placed the bowl into his hands.
“It’s a mix of the broths from the soup your mom brought and that Mama Min brought. You are to never tell them that I did this. Or that while both are good they taste next level combined. I will not be killed because I took care of you,” she said.
At that Hoseok laughed, and then drank down the broth. YN wasn’t wrong about it being better combined, which was part of the reason he downed it despite the burn he felt. Naturally, YN chastised him as he did because she could see the pain on his face, but he paid her no mind. Once finished, she replaced the bowl with the mug and one look inside had him sitting it down.
“You know I don’t like that version of ginseng. Why can’t I drink the other one?” he whined.
“Because it’s the kind that helps you the most and it hides the taste of the medicine you hate so much. This is your own fault for being a wimp and not wanting to drink it down by itself. So drink it,” she said.
Of course, he didn’t do it right away. Hoseok stared YN down and attempted his best puppy dog eyes and pout, but was met with an unamused expression that became more uncaring as each second passed. That didn’t deter hum though, at least not for about a minute or so when it was clearly she only grew more impatient with him.
With a huff he grabbed the mug and quickly downed the shot of ginseng and medicine. He winced in reaction to how bitter it was and immediately snatched the glass of water up as YN took the mug from him. Once he’d downed that as well she grabbed all the dishes and headed out of the bedroom.
“Get comfortable in bed,” she called back.
Upon return she had both of their 34oz water bottles filled up and ready for them to drink through the night if need be. Which for Hoseok was often while sick and because she’d caught a little of his cold she too needed a few sips at random times if she woke up.
After giving it to him, she climbed into bed and slid under the blanket. It may have been summer but they tended to keep their room on the colder side, which meant that they wouldn’t overheat just because they slept under them; which was good because YN needed to be under a blanket to sleep.
Getting comfortable didn’t take them long, since they were both so wiped out from their days. And despite Hoseok’s sickness they cuddled together, because unlike him YN continued her dose of medicine until it was gone. She knew she wasn’t one hundred percent better even when the symptoms appeared to have left her completely.
They stayed cuddled together for about half an hour watching what YN had on before he’d come home. Nothing felt tense or awkward in their silence, just comfortable and relaxed.
But as time went on Hoseok remembered the feeling he’d had upon his arrival home. The worry that filled him when he saw how much she’d cleaned by herself in the time he’d been gone. And the hope he’d had at knowing she’d found enough energy to even make the effort to clean that much in the first place. She’d been out of it for weeks and it was the first major sign that something changed. Or that’s what he wished for.
Hoseok turned his head to look at her, well more like assess her face. It was relaxed and she seemed genuinely interested in what was on the screen and not off in her own little world. Though once she realized he was staring she turned his way and his assessment was over almost as quickly as it began.
“Can I help you?” she asked, her brow raised.
For a moment Hoseok debated telling her no, but that didn’t sit right with him. He needed to say something or it would bother him until he blurted it out. Or there was a chance she’d bottle it all up and not say anything at all because she was fine or she didn’t want to dump on him because he wasn’t her therapist.
“How was your session?” he asked.
There was a momentary change in her expression, but she didn’t let it linger for long. That made him even more worried, but he waited for her to say something. Though he knew if she was holding back and if he should push her.
“It was fine, I guess. Less crying than usual. We talked about all my other issues and saved how I was feeling about my mom for last. I think she hoped that by keeping me in a time constraint of twenty minutes I’d be forced to get out the main issues first and avoid going off into tangents. She was very wrong about that and the appointment ran for half an hour longer than it should have. I’d gotten so worked up that it wasn’t wise to try to force me down quickly,” she said.
Hoseok nodded along and reached under the blanket to grab her hand but didn’t utter a word. Just like her therapist he wanted her to let things out at her own pace.
“I mean it’s getting easier, but I don’t know. How is one supposed to process the death of their mother? And it doesn’t help that on top of that it’s dealing with how we were estranged. Knowing that my mix of apathy and deep hurt are valid. That it’s okay that I’m not as torn up about her dying as I think I should be. That I’m not torn up about losing a chance at speaking to the sibling that I never wanted to deal with because he moved back to the US. Dealing with calls from a slew of aunts and uncles who regularly give no fucks about me, questioning why I’m not there, and why I chose not to be heavily involved in the process. Why I could only show up. Why I didn’t stay longer.”
The more she spoke the shakier her voice got and it broke Hoseok’s heart. She was getting better and he knew that, but he always knew it was a lot to overcome. The loss of her only parent, despite their relationship, was something hard to deal with or so he imagined it. It had even affected Yoongi a great deal since he’d been close to her before too, but he recovered faster.
More than anything, Hoseok wished he could find some magic way to lessen the pain and confusion for her, but he felt just as helpless as when she found out. She’d come to the shop when she still had six hours of her twelve hour shift left to go and looked in shock. Without a word she’d run into Yoongi’s arms as he’d come out of his room after hearing Jungkook’s frantic calls. There she burst into tears, and through the sobbing told them that her mother had been in a car accident and didn’t make it.
None of them, except Yoongi, had ever seen her cry that hard and he tried his best to be her rock, but he broke with her. They broke down in the middle of the shop, falling to their knees as they cried together. The boys decided to close after that and just let them cry, comforting them when they could. And at some point they called Beau and Mama Min to tell them what had happened.
From there, they had to wait until they were calm enough to get them in a car to head back to Yoongi’s place. There they were met by Beau and Mama Min, who accepted them with open arms. The sobbing started all over again and they slowly got them to calm down enough to eat and shower. Everyone assumed it was a sleepover kind of situation, so they’d gotten Jin and Taehyung to swing by their places to grab stuff for them.
The entire night was just everyone surrounding YN on the makeshift nest they’d made. She never once let go of Yoongi’s hand and he didn’t dare release hers. And as they slept she cuddled into Mama Min’s side holding onto her for dear life with her other hand.
Seeing her shattered like that was eye opening for Hoseok, and he tried his best to make sure she was okay. Work gave her two weeks off, but when she didn’t bounce back quickly they extended the leave for a little longer. Then when that ran out she used vacation time she’d saved up. That was the start of when she actually made progress in not being a shell of her former self and Hoseok would tell her to take off all the time in the world if it meant that she’d be better.
But, as Hoseok sat there thinking about how he wished there was something he could do to fix things he realized there was something he could at least try to make her feel a bit better. And it would allow him to do something that he’d been wanting to for a while.
Smiling at her he leaned down and pressed a kiss to her forehead before pulling away and staring into her eyes.
“We haven’t gone out in a while. So, what do you say about us and everyone going out to the beach for a week? We can do it next week too. Go to the beach house and hang out, have some fun,” he said.
For a moment it felt like she’d say no, especially because she looked so emotional, but then she nodded. And Hoseok watched as a smile worked its way onto her lips, bigger and more genuine than he’d seen in a while.
“That sounds like what I need,” she said.
Happy with that, Hoseok leaned down and pressed a quick kiss to her lips before pulling away and snuggling into her. They continued their comfortable cuddly night in and slowly drifted to sleep together. Hoseok’s mind focused on planning things out perfectly until he knocked out.
Tumblr media
The day before they were to leave to head to the beach house YN had planned to spend it packing and relax because the journey was tiresome. However, Hoseok had other plans and just as she finished packing her stuff he called her to come down to the shop for the night. Saying no was an option, but he sounded so excited that she couldn’t help but say yes.
So, on a Friday night when she could’ve been in her home eating and playing video games she found herself in Hoseok’s tattoo room by herself. Upon her arrival she’d been told he’d run out for a second and would be back in a bit. And in that case a bit meant thirty minutes or so after she got there.
Annoyed was an understatement, especially when she saw that he read the texts she’d sent asking him where he was. When it got too much, she got up to leave, but the moment she put her hand on the knob she was stumbling back because the door was being pushed open from the outside.
Hoseok – sweaty and breathing heavily – held bags of food and balanced multiple drinks in a tray. His eyes were wide and his mouth open in that uncomfortable mouth breathing way. Like YN could see the man’s uvula clear as day.
For a while they stood there staring at each other, that was until Hoseok regained control of his breathing.
“Were you about to leave?”
“Yes. You asked me to come at a specific time and you’re not here. Then I have to wait over thirty minutes where you open and don’t respond to my texts. How much longer did you think I was going to stay? Especially since you asked me to come here when I planned to not leave the couch until I absolutely had to all night,” she said.
At that Hoseok frowned. Moving past her a little he placed the stuff down in the tattoo chair that was reclined back. Then he moved to stand in front of her, his hands cupped her face. He stared at her expression and saw the slight bags under her eyes and the lingering sadness. She’d done so well for almost a week following his proposal of the beach trip, but the last day or two something shifted.
Her mother’s husband had found a way to contact her and it had thrown her off. Though the conversation had gone well it had brought her two steps back. Hoseok had woken up to her crying in the middle of the night and through the tears she’d managed to say that she felt like she was doing something wrong despite knowing she wasn’t. Despite knowing she was doing what was best for her and her mental state she felt like it was all wrong. Overthinking her decisions needlessly. The next morning – after he’d gotten her to sleep – she apologized and told him she knew that she was right and having a conversation with her mother’s husband that didn’t go horribly or fill her with anger felt off.
Things got better after that, but it took more than a moment of clarity and a talk with her therapist over the phone to get her back to where she’d been before. And that was why Hoseok had come up with the idea to call her into the shop. Well Jungkook and Taehyung came up with the idea to take her out before they all left, but he came up with what they’d do.
“I know, but I wanted to do something before we left. I swear we shouldn’t be here all night and I got that burger you were craving,” he said, a pout formed on his lips.
The usual thing would be for YN to throw the smallest of fits because she felt so tired, but his stupid face was there and she couldn’t say no. Plus she hadn’t left the apartment much in a week and needed the change of scenery even if it wasn’t a major one.
YN sighed. “Fine.”
With her answer and the small smile he saw fighting to take form on her lips Hoseok finally stopped his pouting. Leaning forward he pressed a quick kiss to her lips before releasing his hold on her face and moving over to the food. He carefully removed everything from the bags and then ran to put two of the four drinks in the tray into his mini freezer.
All the while YN stood and watched him; she hadn’t wanted to get in the way of what he was doing. The man could be anal about how things were handled when he was attempting to make some nice gesture and she’d been on the end of one of his glares before. Though she knew he wasn’t actually mad she knew not to push it further. There was no need for her to deal with a pouty baby later because things veered off plan; especially since she’d shown up before he could get back.
“Okay, so I know you were craving a burger and I went to the place you like and got you a double cheeseburger with extra pickles and a large fry. Also, a sprite and a chocolate milkshake,” he said.
Hearing him list the things made something stir inside YN. After giving into him she’d gotten less annoyed, but that hadn’t meant her mood shifted completely. Despite not being actively sad she felt down and having him get her the thing she’d been craving and getting her out of the house brightened her day. The corners of her mouth even turned up in a smile, something that hadn’t graced her lips once since she’d arrived – or all that day for that matter.
So, she watched as he excitedly continued and reassured her that the things she didn’t like weren’t on the burger and that he thought it would be good for them to sit in his room to eat. There was something about another plan of his, but she barely heard him as she smiled and watched him closely. His smile grew as he excitedly spoke of his idea, causing her own to do the same.
Hoseok was mid-ramble when he noticed that she was smiling at him. A truly genuine one at that. It made his heart beat a little erratically, but he didn’t mind at all. YN’s happiness was his priority and it felt good for him to see that she looked happy, even for a moment.
“Should we start eating?” he asked.
She nodded and he moved one of his chairs over to her so she could sit down to eat her food at the tattoo chair. In many cases she’d object, but the smell of multiple disinfectants told her that he’d cleaned the thing multiple times before her arrival. Plus, he’d laid a paper you’d see when you went to the doctor over the seat, so there was an added barrier from the food and the not so cleanly people who sometimes sat in it.
Though her mouth watered at the smell and the visual of her food YN waited until Hoseok was seat in his own chair across from her. He gave her a pointed look that she knew well from all the times he got annoyed at her not just eating and she dug into it without a word.
Not speaking was something they maintained for a few minutes before Hoseok swallowed a bite that he barely chewed.
“Did you finish getting everything ready?” he asked.
She nodded, because unlike him she liked to chew her food quite a bit before swallowing it.
“Yeah. Everything of mine is packed, as well as stuff we need for the beach, most of the snacks, and I grabbed all your stuff but didn’t pack it.”
Hoseok scoffed. “Good.”
At that she couldn’t help but to roll her eyes.
“You could’ve just let me pack it all for you. That way you don’t have to worry about it when you get home. Plus, you’re going to ask me to help when something doesn’t fit anyway,” she mumbled.
“I can back my own stuff. I’m a big boy. Besides who says I’ll need your help this time, I’m not even taking a whole lot with me.”
There was no verbal response to that, just a shake of the head as she gave up on the topic. At the end of the day she knew she was right and that Hoseok would come to her whining about something not fitting right or being unable to zip the bag. And the solution would be to refold something, rearrange how things sat, or make him realize he didn’t need as many pairs of shoes as he packed. And he definitely didn’t need to bring multiple colors of the same chunky, ugly pair of shoes that she hated.
She wished she could burn them but he loved them too much.
From there silence persisted for a bit and then she randomly turned her head to see a sketch on his wall of an anime she’d watched a long time ago. Naturally, that started a whole conversation about it and how much Hoseok hadn’t liked it as a kid. Something about his sister forcing him to watch it and him not liking the main character. Which led to a discussion about other main characters they both didn’t like. It spiraled into the difference between characters made unlikable as a part of their stories and how some were just not great and people played them off as unlikable on purpose. That didn’t stop people critiquing them though. Definitely didn’t stop YN.
As they talked their food lessened until it was gone. Hoseok took the initiative to clean it up and directed YN to the freezer. She grabbed their shakes and sat the one that was clearly white and black down on his side, grabbing a straw and jabbing it into her own cup. Her lips wrapped around it to pull some of the frozen treat up, but she struggled with how thick it was. When she finally got some out she pulled away with a smile.
“I see it’s up to your standards of thick. Sure you don’t want a spoon?” he asked upon his return to the seat.
YN shook her head vigorously and went in for more. Part of her brain hated the struggle, but the joy that filled her each time she finally got some was too great. The thick milkshakes were always the best.
While she did that Hoseok moved to his computer and turned on some music, his usual tattooing playlist blasted through the speakers. He turned it down when he saw YN flinch and then slid his chair back over to the seat. He grabbed his own straw and milkshake and sucked it down. It was thick, but the normal kind. No part of him had the patience to wrestle with his food or drink, so despite how much creamier it was her way he chose not to suffer.
About half the milkshake was gone before he got up from the seat and snatched YN’s from her hand – despite protest – to put back in the freezer. When he turned around he was met with her pouting and he wanted to give it back but they had other things to do as well.
“There’s another reason I asked you to come,” Hoseok said.
“Which is?”
He didn’t respond, just gathered a few things and prepped his small rolling table for tattooing before pushing towards her. There was no time to process what he meant by the action because then he was whipping off his shirt and taking a seat in the tattoo chair.
His intentions were beyond clear.
“Today?” she asked.
“Today.”
“But I-”
“Aht, no buts. You’re ready to do this and you were so excited to get to tattoo an actual person. So, today you’re going to do me and then Yoongi another time. Probably the others too since they’re all babies who can’t be left out.” He rolled his eyes while he said the last bit.
“That’s so many, I didn’t sign up for that. And why now? I’m not prepared for this. I don’t even have the stencil ready or-”
Again she didn’t get far because Hoseok pointed to a sheet of paper on the table that had various copies of the tattoo they’d agreed on and a pair of scissors.
The man had truly taken the time to make sure that everything was set. Which was sweet, but also spiked YN’s nerves. So much that any sadness that she’d felt was nowhere on her mind.
Hesitation was clear on her face as Hoseok watched her and he worried she was stuck amid her sadness, but then he noticed the nervous glint in her eyes. He found it cute that the woman cut open people for a living and was worried about how her tattoo would come out. Even though she caught onto tattooing faster than anyone in the shop and had the steadiest hand of all of them.
Reaching over Hoseok cupped her face and forced her gaze on him.
“You’ll do fine. We chose this tattoo because it was quick and basic. Line work and some shading. You even did it a million times on oranges, lemons, and grapefruit. It’ll be great,” he encouraged.
There was an urge to protest, but YN didn’t. She rose from her seat and walked out of the room. She went to wash her hands and then came back to slip gloves onto them. She lifted the arm rest and placed his arm on it, careful to look around for a good spot. Hoseok was tattooed almost completely on both arms, but there was a spot on his left forearm that had enough space.
From there she was kind of on autopilot. She cut the stencil and placed it on the spot to double check that it would work. Once pleased she set it back on the table and grabbed an antiseptic wipe to clean the area. She spent way too much time on that, but Hoseok didn’t comment on it. Before she knew it she was actually placing the stencil onto his skin and peeling it off, the thin purple lines transferred perfectly.
By then the nerves had returned and she was ready to back down, but then she made eye contact with Hoseok and he gave her an encouraging smile. She couldn’t stop then, she needed to see the tattoo through.
She got the gun and the ink ready, but the vibe felt off. So, without a word she rolled over to the computer and pulled off a glove. There were several clicks before Jonghyun’s beautiful voice filled the space. It was the first song on her surgery playlist and in a way tattooing was like that, so it was the perfect relaxer.
After replacing the glove she took off with another one she got to work. The tip of the needle dipped into the black ink and using her free hand she pressed Hoseok’s arm down and began the tattoo.
The design was a crescent moon – which would be shaded in – and a sun combined. Where the moon stopped lines and dots of varying lengths were used to make clear that it was the sun. Nothing intricate, but still something she worried about messing up.
Her movements were careful and steady, her hand moving easily as she traced the outline of the moon. It took her shorter than she thought even with her excessive wiping, but she wasn’t pleased with the outcome. It wasn’t bad at all, basically perfect. However, she’d been so nervous that the lines were too thin.
“If you want it thicker you can do it. I know Yoongi worked with you on that the last few sessions. I only taught you to start with thinner lines just in case you’re unsure,” Hoseok offered as if he read her mind.
YN nodded, chewing on her lower lip as she went in again. That time her lines were a little heavier and though part of her worried that it was a mistake to make them that thick, by the time she’d finished and wiped the excess she was pleased with it.
Being happy with her outcome meant that she felt more confident, which meant she went into the next part with less worry. She shaded the moon in with vigor and had to mutter a few apologies when Hoseok whined about her being too aggressive. It was just that she got excited and so into the work.
Which meant that she didn’t notice Yoongi when he’d silently entered the room. He stood behind her, though about a foot away so he wasn’t crowding her. Him and Hoseok watched as she finished the shading and went on to the lines to create the sun. Her hand moved carefully as she did and though there were a few curses when she thought she messed up, there were also those lightbulb moments when she realized she could make up the length with a few extra dots. Nothing ruined at all.
Once finished she set the gun to the side and carefully used the other items on the table to clean it. Seeing the cleaned version had her scared it was a mess, but the more she stared at it the more she liked it.
“You did good. How the hell did you get that to curve so fluidly?” Yoongi said, startling her with his sudden presence.
“She was so worried she’d mess up, I told her it would be fine,” Hoseok said.
Involuntarily, YN rolled her eyes. They enjoyed double teaming her on everything, but self-doubt was by far their favorite.
“Let the man see the new tattoo,” Yoongi said, playful nudging her shoulder.
Her eyes widened as she remembered he couldn’t see it well from the angle he was at and she moved away from the chair so he could get up. Hoseok immediately went over to the floor length mirror hanging near the door. He held out his arm and examined it closely – and for way too long – without saying anything. If he hadn’t smiled before he spoke she would’ve thrown up in fear he hated it.
“I told you, you’d do good baby,” he said.
Tension melted from her body at that and Hoseok watched on in joy. Not only had she accomplished her first tattoo, but she also appeared genuinely happy. There was nothing about her that exuded sadness or showed that she was even vaguely in a low place. It didn’t mean she was completely free from the thoughts, but it did mean that she wasn’t caught up in them enough to show any outward reactions. And since she wasn’t the best at keeping her emotions hidden and bottled up that was a win.
From the eye contact he made with Yoongi for a moment the older male also appeared to think so. Flashing Hoseok a thumbs up when YN wasn’t looking.
The first part of Hoseok’s plan was a success.
Tumblr media
The trip to the beach was long and started early. They’d rented a twelve-seater van to drive there and alternated drivers. Jungkook, Yoongi, and YN switched out every two hours so no one got too complacent or tired with the six hour drive. It was trying sometimes because of stupid drivers or someone complaining too much, but they made it there without anyone killing someone else.
A true win.
They arrived at the beach house late afternoon and decided they’d spend that night in. None of them had enough energy from the trip to anything and they had a full week to venture out. Plus avoiding the massive crowd on a Saturday night was a win.
Food was ordered in front various places because everyone either wanted something different or couldn’t make up their mind on what they wanted at all. Dinner was eaten and though it started off with minimal conversation they all eventually started talking about random things and eventually it led to talk of what they would do the next day. Hoseok mentioned something about the amusement park nearby, which got YN excited immediately and everyone agreed with that.
However, the quickness in which they all said yes wasn’t lost on YN despite her excitement. Usually they all took forever deciding what to do on any group outing and when they did there was some sort of whining. But everyone had agreed and then went about eating like everything was fine. No questions asked. No adjustments to time. No concerns about being there for so long. Just compliance.
It was something YN planned to ask about and fight against if they were doing it because she wanted to. Them giving in just because it would make her happy because she’d been so down wasn’t something she was okay with. The thought was nice, but she preferred they did their own things if that’s what they wanted. But she didn’t get to ask because everyone finished and before she knew it Hoseok escorted her to their room.
And like clockwork her body felt heavy the moment her eyes laid on the bed. Not even the pretty view from their balcony could draw her in. Which made it easy for Hoseok to maintain control to get her in the shower and then bed in the matter of thirty minutes.
By the time her head hit the pillow she felt refreshed, but like she’d cried for a few hours straight. The kind of tired where you don’t really feel one with the world and everything is almost like an outsider looking in. Though when she looked at Hoseok he grounded her a bit.
He took a few minutes longer to get into the bed after she did, slipping in wearing nothing but his boxers. Which was fine because she was in short shorts and a crop top. Something that seemed to warrant him poking her stomach every so often, which she allowed to happen because she didn’t have it in her to stop him.
Hoseok knew what he was doing too and that he’d pay for it once she slept, though she tended to forget things when too tired. But he stopped his poking and prodding after a few seconds, preferring to pull her close so they were cuddled together. Her leg thrown over him and their faces resting inches away from each other. He wanted to stay up a little and talk, but her eyes were closed and her breathing slowing.
For once she didn’t argue about it only being 8:00pm and thus too early to sleep. She’d say that every time they went on a trip, but more than anything she’d been saying it since after her mother’s funeral. Even when she looked exhausted and mentally not there she refused to sleep that early. So it felt good to see her not do it for once and after placing a kiss on her lips that thought lulled Hoseok to sleep.
Because they’d fallen asleep so early everyone was up at around seven the next morning. Well, everyone except for Jin, Beau and YN. They’d all woken up and ventured out of their rooms at around five almost six and decided yoga was the move. They gathered on the back patio of the house where you could see the beach and got to work.
Yoga was something that Jin and YN did regularly. The hospital had classes for all the staff to take and they’d gone with no intentions to ever do it again, but then realized how good they felt the days after. From then on they went to the classes or met up in a secluded part of a park early in the morning to do it before going out for breakfast or something. Beau joined in once when YN did it at home and then usually join her anytime he saw her doing it. Sometimes even joining her and Jin when they ventured out.
It was a great first moment of the vacation and one of the few times she’d felt so at peace in a long while.
From there they showered, got dressed, and went down to make breakfast. They’d picked up some groceries before getting to the house so they didn’t have to worry about it later.
By the time they finished everyone was up. Food was consumed at an alarming rate and everyone got ready with the same quickness. They wanted to get to the park at opening so they could have a better chance to get on everything. Which led to a lot of yelling and rushing people to hurry up and get to the van.
Hoseok took it upon himself to drive them there and as the rides came into view the closer they got the more excited YN got. She bounced in her seat and almost opened her door before the car came to a full stop.
That was dangerous and with the way Yoongi looked at her Hoseok thought she’d get scolded, but in fact the older man was upset that she tried to cheat. Which confused Hoseok until he whipped the door open and sprinted towards the entrance, YN hot on his heels and yelling about who was the real cheater.
It was like watching two children and goodness did it make Hoseok feel good.
When the others reached them they both stood there with big smiles and holding wrist bands, all of them the kind that were used for those with fast passes.
Hoseok narrowed his eyes at them, but neither of them looked regretful about what they’d done. In fact, they both appeared way too smug.
“What did we say about you two buying everything before anyone gets a chance? It’s not allowed on this trip or any trip,” Beau said.
Yoongi and YN turned to each other and shrugged, then thrusted a wristband into everyone’s hands. Since it wasn’t their first time out with the two amusement park junkies they all knew to get the bands on quickly, as if their lives depended on it. Yoongi had once wrapped Jungkook’s so tight that it limited circulation in his hand and they had to get another.
No one wanted to repeat that.
Without missing a beat they walked towards the workers scanning people in, leaving the others to catch up. Both of them were several feet inside the park by the time the others caught up again. They stood perfectly still and took in the park. One could feel the excitement that radiated off them.
It took Taehyung clearing his throat multiple times before they turned to face the rest of the group. Though that only lasted for a second before they were focused on each other.
“We meet here in four hours?” YN asked.
Yoongi nodded. “Right here and then I kick your ass in everything.”
That made YN scoff but she refrained from any trash talk in retaliation, there was always enough of that during them playing the games. Besides her focus was on something else.
Off in the distance was a ride that was way too high and moved way too fast – by even her standards – but the expression on her face showed how much she wanted to try it. So, without a word to the others Hoseok walked forward, grabbed her hand, and headed towards it. Everyone else went their own way, except for Jungkook and Taehyung who followed behind them. Hoseok felt like he was going to be sick the whole way, but YN and Jungkook reassured him the whole time while Taehyung poked fun at him, though it was clear that was only to calm his own nerves.
Once on the thing they all were ready to shit themselves but pushed through and as the it reached the first drop. YN and Hoseok made eye contact for a second and there was a reassuring feeling that flowed through them, but the next thing they knew they were sailing through the air so quickly it took a moment for her to breathe properly again.
The entire ride there was no moment to relax or get used to it. Even knowing what was to come didn’t make it any easier to adjust.
It was exhilarating.
That feeling is why Taehyung and Hoseok ended up waiting as YN and Jungkook went on again. Neither of them wanted to relive that and the fast pass line wasn’t that long, so they just sat on a bench a few yards from where the line-up started.
“So, are you going to do it today?” Taehyung asked, his voice a bit strained.
At first Hoseok was confused by the question and then it dawned on him what he meant. A different kind of discomfort settled in him at the thought of saying yes and so he shook his head quickly.
“Definitely not,” he muttered.
Taehyung turned to look at him with a raised brow and confusion.
“I thought that was the plan? Get her all happy and then do it? Don’t tell me you’re chickening out?” he teased.
Hoseok reached over and lightly punched his shoulder, a soft – but nervous – laugh escaping his lips.
“I’m going to, just not today. I want to make sure she’s good first. I’d hate to do it while she’s still wrapped up in sadness. That would make the whole thing much more complicated than it already is.”
At that Taehyung shrugged and turned his attention back towards the ride. They sat in a comfortable silence watching it climb high and then drop, looping a few times before it climbed again. It was more nerve wrecking watching it move like that then being on it, but that didn’t mean that Hoseok wished he was on it instead. He never planned to get on that ride again if he could help it.
About twenty minutes or so passed before they both returned and then everyone was off to other rides. They were all their own level of terrifying, but as they ran from ride to ride Hoseok got used to the fear and thrill that came along with them. He’d even agreed to go on one twice, which made YN beyond happy. Especially since she could see the eagerness was genuine. As if him being the one to request they go again wasn’t clear enough.
They continued on like that for a while, though eventually Jungkook wanted to circle back to get on something they’d all said no to. He convinced Taehyung to go with him and then Hoseok and YN were traversing the park alone.
A few more rides after the departure of the others and Hoseok forced a stop for food. Which wasn’t a whole lot and less than Hoseok would’ve liked her to eat, but it was more than she’d had some of the days from weeks before. A win in his book.
Before they went to get on some more rides they stopped to get a dessert, which was ice cream wrapped in a crepe. The park hadn’t had it the last time they’d come to it and that made YN all the more eager to indulge. They reminded her of ones she’d had in Japan when she’d gone for six months to study in high school. They tasted like them too.
“I don’t know if I should get another one now or later when we’re about to leave,” she said.
Hoseok laughed as he watched her devour it.
“I think I saw a stand with it near the entrance so you can get it when we leave,” he offered.
Though she looked conflicted at first, she smiled and nodded after a bit. No matter how practiced she was at eating and getting on rides too much dairy was a mistake. Fifteen-year-old her learned that the hard way.
After food was consumed, they went on a few more rides and then headed back toward where they were to meet with fifteen minutes to spare. The walk was taken slowly and they intertwined fingers as they went.
It was a moment of peace among the chaos and when YN looked at Hoseok with one of the brightest smiles he’d seen in a while he felt near tears. She’d been so happy and never once did her expression falter or her body language shift negatively. There was so much freedom and joy radiating from her and despite his optimism he’d been scared she’d stay shrouded in darkness for forever. So to have that voice in his head silenced because she was there and existing outside of it was just the best thing to happen to him.
Everything wasn’t fixed, but it was better than nothing.
Yoongi was at the meeting point with an irritated Beau who held a large stuffed bear. Most would question why Beau looked that way, but by the shifting that Yoongi was doing and the wide smile it was clear that he’d challenged his boyfriend to a few games and then mercilessly beat him.
Upon seeing a smiling YN though Beau’s expression shifted to mimic the smile on her face and so did Yoongi’s for a moment. However, YN was in competition mode and when he noticed that he was as well.
Not a word was uttered between them as they left their significant others to head towards the games and neither of them said anything about it. They merely trailed behind them and watched as they tried to one up each other.
Who knows how much time passed or how many prizes were handed over to kids or anyone standing nearby before everyone was gathered together watching them. Though it was tiring to stand there and see them go on forever there was also this mutual contentment as they all looked on. It was as if they were all on the same wavelength with how nice it was to see either of them back to some sort of normalcy.
“Has she been like this all day?” Beau whispered.
Hoseok nodded, his eyes never leaving them.
“Yeah. She’s been so happy and carefree. I don’t think she’s thought about it once all this time. And it doesn’t feel like she’s faking it,” he said.
There was a nod from Beau in response and then all the focus was back on them.
YN being that happy that quickly wasn’t what Hoseok foresaw at all, but it was nice to see that the second part of what he planned worked out well. He only hoped that it was doing some actual, concrete good for her mentally and that the last part of everything would go as smoothly.
Tumblr media
Four days into their trip YN decided that Hoseok was acting weird. Though weird was something normal for his behavior it was a different type. He was attentive and kind, but also drifted off into his own head a lot and didn’t put up a fight when asked to do something that wasn’t necessarily in his comfort zone. She hadn’t pushed his limits by any means and accepted no when he said it, but for the most he gave in without a second thought.
Of course, his efforts were appreciated greatly, but that was what worried her the most. She knew how down she’d been and how the call from her mother’s husband had changed her. It was clear as day to her how she was acting and she wished she could snap her fingers and stop, but that wasn’t possible. And since she knew that, so did Hoseok and that meant he’d ramped up on trying to keep her at the very least not actively sad. All his free time was spent trying to help and look after her. The trip was just another one of those things and though she jumped at the prospect of being away from home to enjoy herself – and had enjoyed herself – she feared him taking things a step too far to please her.
No matter her mental state there would be no excuse for any damage she could do to his if that was the case. So YN planned to talk to him about it one morning, but she was redirected by Yoongi to get ready. Apparently he wanted to take her out for the day, just the two of them. Something she happily agreed to on the compromise of her going to talk to Hoseok about a thing first, but that was shot down by being told he’d headed out a few minutes beforehand. Which meant she had no other choice but to do as she was told, but with a pout.
Despite her mopey mood she didn’t take long to get dressed. Mostly because when she’d entered the room she found a pair of shorts and one of her long sleeve tops laid out for her. Yoongi promptly informed her he didn’t want her taking forever so he’d done it for her. It wasn’t out of the norm since he’d done it many times throughout their lives because supposedly she moved too slow or always grabbed the one thing in her wardrobe he hated with a passion. After a while she learned to just let it happen.
Once ready to go Yoongi grabbed her hand and practically dragged her from the house. It took some begging and mild threats to get him to not hold her hand so tight and slow down. From there he was less aggressive, but still held her hand firmly in his. She was fine with that because it was a habit from childhood that they never grow out of. As long as his bony fingers didn’t dig into her hand or squeeze too tight she was fine.
During their walk they didn’t speak, which was fine. They both tended to be quiet people and silences were rarely awkward. Walking for ten minutes to the nearby cafe bookstore was nothing in the realm of how long they could be around each other and not utter a single word.
“I wanted us to relax before dinner later. You know they’re all going to get drunk and it’ll be a mess. So, some peace and quiet for now,” Yoongi said once they entered.
That made YN smile wide. Even without the reason she loved the idea of spending a few hours there.
“You sure it’s not because they let you take naps here whenever we come?” she teased.
Yoongi laughed. “That too. A peaceful nap.”
With that she nodded and finally removed her hand from his. She shooed him away to see if any good seats were open and then headed off to buy their drinks. All of her will was used not to stop and look at books that caught her eye as she walked to the counter. The man wanted a nap, but him waiting too long for his favorite hot chocolate wasn’t on the table. Plus, there was something about being inside the place that calmed her so much that she was a bit tired herself.
After she grabbed the hot chocolates she searched for him and was beyond happy to find him at the reclining chairs in a back corner. Not daring to destroy the nice atmosphere of the space she merely handed him his drink and plopped down into her own chair. Her body relaxed instantly. It was asking her to sleep, but she wanted to drink her hot chocolate first. That lasted maybe ten minutes before she and Yoongi drifted off.
Sometimes she didn’t remember how much having a good time and being happy could drain from a person, no matter how much sleep they got.
When they finally woke up, panic filled YN because she’d misread the clock as saying four hours had passed, but it was barely an hour. The darkness only exacerbated that, but she was thankful her eyes adjusted before she shook Yoongi awake.
Since she felt refreshed from the nap the urge to explore books overcame her again. Instead of ignoring it she left Yoongi to continue his napping and looked around the store.
A lot of what did interest her were things she had read, were on her to read list, or by someone who wasn’t the greatest person despite their excellent writing. The things she did find that didn’t fit into that were all so tempting and she wanted to get them all but knew better than to do that. Her to read list was long and she didn’t need a million more books. So, she settled on getting the top three and took pictures of the others to buy at a later date.
By the time she made her purchase Yoongi had woken up and joined her at the register. He appeared rested and much peppier than he had before, which made her happy to see.
“Should we head back now?” she asked.
He nodded and then they were holding hands and walking back to the beach house.
The silence on the way back didn’t exist. Yoongi asked about what books she’d gotten and some other book she’d gotten a while ago that he’d been interested in. She agreed to give it to him and just as they reached the house and she prepared to ask if he wanted the book’s sequel as well he stopped abruptly.
Confusion coloring her face YN turned her head to look at him and was met with a tense expression. However, before she could question it he spoke.
“You’re okay, right? Actually okay, not the fake okay?” he asked.
YN felt a pang in her heart and her eyes watered for a second, but she pushed that all down. She wouldn’t dare make him more worried than he’d already been, especially when there was nothing to worry about.
“I’m okay. In fact, I’m as close to content as I’ve been in a while,” she said.
His entire demeanor changed when she said the word content. It was a signal of sorts. Something that they’d both learned they wanted through therapy. Happiness was great but being content and not so much good or bad was always the goal. As long as they could reach contentment all would be fine.
Though relaxed he didn’t stop staring her down for a moment and then after a firm squeeze of her hand – that she returned – he started walking again.
Inside the house everyone was putting the finishing touches on the dinner they’d decided on for the evening. It was a night in, which meant cooking and Jungkook had said that meant it needed to be an extra meal. So, him, Jin, Jimin, and Namjoon had spent a lot of time getting everything prepped and cooked. YN had wanted to help and even offered once Yoongi and her returned, but they were done and shooed her out to the patio so they could bring the food out.
Hoseok, who she’d seen maybe twice that whole day, pulled her down onto the seat next to him and immediately moved in for a kiss. That elicited some gagging from Beau which was met with a middle finger from both Hoseok and YN all without pulling away from each other.
They did part when the first of many dishes were placed on the table though. And without hesitation – once everyone was seated and Jin gave his go ahead – they began grabbing the things they wanted or moving them in range.
There was just so much. They’d made kimchi stew, bulgogi, pork ribs, fried rice, curry, and braised chicken. And of course, enough white rice that would satisfy even YN.
Bloated wasn’t even the word that truly captured how YN felt by the end of it all. Though happy was definitely a descriptor. They’d eaten, talked, and down alcohol. Jokes and stories were told, laughed about, and denied with intense vigor all around. It was a peaceful moment despite the chaos and watching her family just be together always filled her with such joy.
She could stay like that forever, but of course that was a no.
About thirty minutes after she’d had her last bite Hoseok suggested they go on a walk while they waited for the others to return with the chosen dessert. No was on the tip of her tongue, but he reminded her walking could help her feel better. Plus, he had a look in his eye that reminded her that she’d wanted to talk to him about something before.
So, they kicked off their shoes and headed down the beach. Hoseok laced their fingers together and led her away from the house. At first they said nothing, but then at the exact same time they spoke.
“YN-”
“Can we talk-”
They both paused and looked at each other with wide eyes before descending into laughter. It took a moment or two, but they collected themselves soon enough and continued their trek.
“You first,” he said.
YN nodded. “I want to thank you for all of this. It was what I needed and I’m so happy to have all this time with you and everyone else. Being with the people I loved most and who love me. Having fun that I haven’t had in a while. Having moments where I feel content, even if it’s fleeting. I haven’t had a bad day for the last few days and I haven’t even thought about anything really. And even if I did it was such a fleeting moment that I only barely remember it happened at all.”
“But?” Hoseok said when she paused.
“But I worry about taking advantage of all of you. I know that I’m not and everyone is happy to be here for a good time and to offer all the support in the world. I know that that feeling is for naught. But I realized how much you’ve given into me the last few days and it makes me feel like I may be crossing a line. You’ve had to deal with me being distraught and not myself for weeks. Never able to escape that unless out at work or I’m with someone else. And then you plan this and you give into my every whim. You do things that I know make you uncomfortable. Even if I’m not pushing you on certain things and I know I’m not crossing any hard lines it still feels wrong. And I’m sorry about that,” she said.
That ended in them coming to an abrupt stop. Hoseok released her hand and moved to stand in front of her, his hands moving to cup her face.
“Baby, you don’t have to worry about any of that. You have not crossed a line or made me do anything I didn’t choose to do. I’m fine. Did I agree to a few things that scare me or make me cautious? Yes. Did I do them partly because they made you happy? Yes. But like I said, it was my choice. I wanted to try them and that was an extra incentive. Seeing you smile or be in the moment was the greatest incentive in the world. I wouldn’t change doing those things. And I know you’re worried about what all this or your behavior could have done to my mental health, but I’m good there too. It hurt me to see you like that, but I processed that in therapy. Dr. Seo was more than willing to take me in more than once a month to process all this. I swear to you I’m fine.”
There was clear uncertainty in her eyes despite what he said. Hoseok could see it and though he wished she’d just believe him he knew that wasn’t how the mind worked. Sometimes things took a while to process or a little more assurance needed to be given.
After taking a deep breath he leaned down and pressed a gentle kiss to her lips, one she returned without hesitation. When he pulled away one of his hands slipped from her face as their foreheads pressed together.
“I love you,” he whispered.
“I love you too.”
The next few moments happened in a weird space where everything moved too fast and too slow. Hoseok’s other hand moved from her face and he pulled away from her, but before anything could be said or done on her end he was down on one knee with a ring in his hand.
YN had no time to process it before he started talking.
“This week was about making you feel even an ounce of happiness, but it was also about finding the right time to ask you. YN you know I love you with my entire being. How you love yourself, me, and our little family brings me such joy. How you live to be the best you and know that you’re not always going to get it right. How you know yourself enough to know how to handle your problems. You realize how off you’re being and take the time to self-assess, not just because of you but because of me. So you’re not doing anything that could affect me. That could lead to unintentional behavior that could harm me. You grow so much all the time and it feels impossible for you to put forth any more effort than you already do.
“You just make me feel so happy. Doesn’t matter if it’s from watching you be that way, you making me feel that way, or the reminder that I can be happy on my own despite you. That I can stand alone in happiness that doesn’t revolve around you or anyone else. Something I struggled with so much before. You’ve helped so much by just being you. And though I know that we have cemented our relationship already, I still want to do this. It would truly be the best thing in the world if you married me, baby.”
YN had worked through the initial shock and was much calmer than when he’d started talking. Her brain fought to keep up with the words and her heart soared as she took them in. It’s why she didn’t hesitate in responding with a yes.
Without missing a beat Hoseok slipped the ring on her finger and rose onto his feet. He pulled her into a tight hug and whispered ‘I love you’ over and over. In the distance there were cheers from their friends who had watched on from the back patio. She hadn’t even realized they’d turned and walked back towards the house once she’d started talking. But that didn’t matter at all. At least not in that moment.
The calm that she felt mattered. The excitement she felt mattered. The content feeling that washed over her mattered.
110 notes · View notes
Text
The Cuddlist (2/3)
Tumblr media
ProfessionalCuddling!AU. Maybe going to a professional snuggler was the craziest idea Emma ever had, but it certainly wasn’t her worst. In fact, weekly cuddling with Killian Jones could’ve been the best decision she ever made.
Inspiration for this fic finally struck (after over nine months) and I thought it would be the perfect opportunity to surprise @swanandapirate, who has been studying her butt off. This fic is for her, my sweet love! I hope you all enjoy it just as much. Special thanks to @phiralovesloki who gave me feedback of immeasurable worth. This fic would have suffered without it.♥
Note: This chapter contains very brief and non-descriptive mentions of a client crossing personal boundaries toward the beginning. 
(Rated T)    (6k words)   (ao3)   (chapter one)
Session Six
Emma Swan was Killian’s favorite appointment. His magnetic refrigerator calendar - a sailing themed one - had all his clients and the times they would arrive printed in his flourished cursive with black ink. Swan’s name had been written in a light blue color slightly larger than the rest of the things he’d written on his schedule.
It was the one thing he looked forward to. Emma Swan. Every Wednesday. Noon to one in the afternoon. His midweek break.
Don’t get him wrong, he loved every - well, most - of his clients, and he loved his job even more. He’d seen so much change in so many people, it was hard to not become addicted to the warm feeling he got from giving therapy.
It was just that Killian wished he liked all his clients as much as he liked spending time with Emma, but not of all of them could be as great as her. She didn’t know, but in the time he had met her six weeks ago, he had turned several people down for a second or third appointment. It was one of the few downsides to his job. Some people wanted more than a friendly presence.
And he had decided years ago, without question and without much thought, he was not going to be a male escort, contrary to what some people expected from him.
Take for example the woman in his arms, who was one such person. Cora Mills. One of his older clients, Killian knew that she had acquired quite the sum of money from a strange marriage to a younger CEO. It was the only time someone had abused his confidentiality policy to allow for their cheating habits. Because sure, the touches were platonic on his end, but the way she tried to feel all over him made him squirm.
Especially the way her hand was trailing up his thigh. Killian felt a wave of nausea flood over him. He caught her hand before it could travel too far up, and clutched it into his chest.
“Boundaries, love,” he reminded in his most professional cuddlist voice.
“To have fun, one must push boundaries, darling,” she replied, sickly sweet in his ear. She tore her hand from his grasp and moved to continue her search along his thigh, but Killian jolted back.
“Cora, I’ve asked you more than once,” he said sharply. He spun away, standing up and putting distance between them. “And I shouldn’t have to. I’m afraid I have to ask you to leave.”
“I paid for an hour.”  Killian glanced at the clock, relaxing just an ounce to see it was 11:59am.
“And an hour you got, ma’am.”
Just as Cora opened her mouth to argue, at which point Killian planned to call the police, a steady knock resounded throughout the room from the front door. He could have cried in relief. Emma Swan truly was a savior.
“It’s open!” Killian called, before Cora could intervene.
Emma came tumbling into the room, as radiant as the sun peering behind the fall leaves. She wore a white turtleneck sweater tucked into a burgundy skirt, the personification of autumn spirit. She smiled as soon as she saw him, leaving a warm feeling in his chest, but paused as she caught sight of Cora.
“Did I interrupt?” she asked, glancing down at her watch. Killian shook his head, trying to show just how thankful he was in his heavy stare. Her smile twitched, a minute sign that told Killian she caught how perturbed he was.
“Not at all, love,” he answered. “Miss Mills and I were just finishing up.” Both women in the room could tell his tone meant finishing up for good.
Like a tempered child pouting, Cora slipped her shiny black heels on, grabbed her wool jacket, then clacked across the room toward the door.
“If he refused me, don’t expect him to keep you for very long,” he heard the woman murmur to Emma, but the door had slammed behind her before Killian could voice just how very wrong she was. He planned on keeping Emma around for quite some time if he could, thank you very much.
But just having the woman gone was enough to make Killian’s pulse slow down and his hands stop trembling. Emma was by his side at a second, a comforting hand on his arm. He closed his eyes and focused on steadying his breathing. A hand come up to cover Emma’s on his arm, offering a gentle squeeze.
“Are you okay now?” she asked.
“Aye, love. You have immaculate timing,” he replied, voice hitching on the tightness winding in his throat.  Emma dropped her hand to give him some space, but the loss of contact made Killian’s nerves thrill under his skin.
“Though perhaps we should reschedule. I’m afraid I’m in no condition to give you what you paid for.”
It was unclear just what she was thinking as she held him in a scrutinized gaze. He felt frozen to the floor, knowing that if she showed even the slightest sign of disappointment, he would take it all back within an instant.  
There was no disappointment in her eyes. There was only something akin to understanding, and a fiery bite of rage that she seemed to have held back by a single thread.
“Give me your phone,” she demanded gently. Killian’s hand immediately reached toward his back pocket, but then he hesitated.
“Why?”
“Just hand it over, Jones. Weren’t you the one who taught me about this whole trust thing?” It was enough for him to comply, and within moments, she was pattering away at the screen with furrowed eyebrows.
“You said her name was Mills?” she continued, fingers scrolling up through a list. “Cora Mills, there she is. And…number blocked. She won’t be able to call you again.”
Emma paused, waiting for him to respond. As Killian took back his phone, his mouth was locked in a gape, searching for some way to answer. All words had escaped him. There was nothing but this woman before him, so stable and sure.
“I was going to-” he finally tried to defend.
“No, you probably would’ve thought about blocking her number and then let her call you back, only to forgive her and rinse and repeat whatever happened in here today. She’s not worth the anxiety, Killian.”
His pointer finger found the spot behind his ear that prickled when he was nervous. Of course Emma would understand. Other people in the past had criticized him whenever something like this had happened, subtly claiming that it was his fault for putting himself in such an intimate profession. He was wise enough to know that it was never his fault, but it never made it less horrible when it did happen.
When he looked up from the floor, Emma was lounging across his couch with a massive chinese menu in one hand with the other dialing a number.
“What are you doing?” Killian asked. “And where did you get that?”
“Ordering lunch.  I never leave the house without a take-out menu,” she replied, as if it were obvious. Killian sauntered over to her, pulling her phone and menu from her hands just as she finished dialing the number.
“Darling, I told you. I can’t today.” Killian began to fold the expansive menu, but Emma plucked it back just as quickly.
“Look, I’m ordering you lunch, sticking around to make sure you let me pay for it, and then I’ll be out of your hair,” she explained casually. His incredulous stare prompted her to add one last clarification. “You spend every day pampering people, but you never have time to let anyone pamper you. I’m not here as a client, I’m here as a friend.”
A warm rush spread through Killian. Her presence seemed to brighten the room in a way that was almost therapeutic. He considered all his clients his friends to eliminate the awkwardness of holding a complete stranger, but it wasn’t often the other person reciprocated.  
He suddenly became aware of something: there was nothing he liked more than being Emma Swan’s genuine, bona fide friend.  
Within the hour, they were sitting shoulder to shoulder, white cartons in hand and stomachs filled with delicious food. Killian could sense Emma’s relaxation radiating off of her, coming off in gentle exhales.
“I’m glad you stayed,” Killian admitted. His eyes stayed glued on his fork searching around for tiny pieces of chicken lingering at the bottom of his take-out box.  
“Me too.” Emma set her empty container on the table in front of them. “Do you want to talk about what happened?”
“A woman violated our client-therapist agreement which resulted in her permanent removal from my services. What else is there to talk about?”
“And you’re okay?” Emma placed a comforting hand on his knee, a touch that seemed to pull the answer right from his lips.
“Yeah,” he said on a breathy exhale. “I think I’m okay.”
Any sourness left over from the incident earlier was erased away minute by minute as Emma put his favorite indie movie on the TV. As gentle acoustic music played behind the opening of the film, Killian leaned his head into her lap, cheek nuzzling up with the soft fabric of her long skirt.
And maybe Killian’s heart raced as Emma threaded her fingers through his hair and scratched at his scalp. Maybe her touch was just what he needed to send away everything nasty he’d been carrying, leaving room for her comforting presence in his heart. He nearly suggested that she become a cuddle therapist herself, but the very thought of her hands on someone else sent a recoiling scowl down his face.  
If Killian Jones was developing a crush on Emma Swan, then no one needed to know. It would probably go away before anything could become of it.
* * *
Except that it didn’t. If anything, Killian’s growing infatuation was only getting in the way of his work. He’d have a lonely widower in his arms, but find himself aching for her touch. His routine of massages was muddled with the thought of her creamy skin and lovely smile.
It didn’t help that Emma started scheduling appointments for twice a week, rather than their usual single consultation. She even had a habit of popping over when she knew he wasn’t busy and visiting as a friend, rather than a client.
Eventually, their dynamic shifted without any spark or prompting. It was organic, their relationship growing in a way that friendships do when the people and the conditions are right. It started as timid text messages - Would you care to come over for pizza tonight? I rented Back to the Future. - and shifted into Emma’s sporadic visits after his business hours. She did occasionally schedule an appointment with Killian the Professional rather than just popping over to see Killian the Friend, especially when she had some extra money saved and work was wearing her down.
It was good. It worked.
Killian blamed habit of routine for the way they always ended up tangled together in each other’s arms.
* * *
“How many sessions does this make?” Emma murmured into Killian’s chest one day. They’d been laying like this on his couch for an hour, legs a tangled mess. There were few places she liked being more, held by her best friend while his fingers rubbed along her scalp.
“This isn’t even a real session,” he answers, his breath whisking through loose strands of her hair.  
There were certainly benefits to your best friend being a professional cuddler, Emma decided. For one, he was naturally affectionate. Gentle touches and warm hugs came easy to Killian, a talent Emma had always been glad she didn’t have. It was different now that she’d felt the comfort of his embrace, so she thought she’d make an exception. And boy, was she glad she did. From that day on, Emma spent the end of her stressful days in the company of a friend who genuinely cared about her, made her laugh until her stomach was in knots, and gave a damn good foot massage.  
Of course, there were also disadvantages.
Like the intrusive thoughts that Emma certainly did not ask for,  the ones that insisted that she was nothing special to Killian Jones and that he was only being nice to her to earn money off of her. Or worse, that he was just like every other guy she’d been with who always seemed to take advantage of her.  
The one thought that really kept her up at night, the one that she was most ashamed of, was the small tiny voice in her head that admitted that she was falling for him. Getting feelings for Killian was absolutely, under no circumstances, allowed. She’d signed the agreement and everything.
“Swan, if you think any louder the neighbors are going to start complaining.”  
Emma jolted a little in his arms, like she’d been caught doing something she wasn’t supposed to. Shaking her head, she leaned up to burrow her face into the side of his neck and muttered an unconvincing, “I’m fine.”
The hand weaving through her hair moved down her back, his fingers gliding over her skin. He was waiting for her to say it, because they both knew that something was wrong. There wasn’t any point in trying to hide it from him.
“Can I ask you something?” she asked in a low voice.
“Of course.” Killian held her in place as he shifted against the couch so that they could face each other. It was a tight fight on the small cushions, and Emma could smell the spearmint on his breath. It was his eyes that coaxed the question out of her, the way they didn’t judge or hold suspicion.  
“How many people do you do this with?”
Killian gaped at her. Smooth, Emma she sneered at herself. Real smooth. He was careful to keep his expression fixed, though she swore she saw the slightest hint of offense dampening the light in his eyes.
“Do what, exactly?”  
“Spend time outside of consultations.”  
Killian sat up, taking Emma with him that she had nowhere else to look but at him. His brows furrowed, gaze intense. Running his hands down her arms, he locked their fingers and squeezed.
“I love each of my clients, and I like to think that I’m not just their therapist, but also their friend.” Emma opened her mouth to interrupt, take back the question, change the subject, forget that she even mentioned it , but he stopped her. “The people that visit me all have their own lives, their own friends, their own families. Many of them are embarrassed to admit they see a professional cuddler, so they leave me separate from their real lives.”
“Does that bother you?” she asked.
“No. People don’t keep in contact with their chiropractors or dentists, I don’t expect them to treat me differently.”
“But I’m different?”
A smile broke on his lips. “Very.”
Emma could feel the heat rushing to her cheeks as he grinned at her. All her life she’d been ordinary Emma. Nothing special to her foster parents. Nothing special to her teachers. Nothing special in general. But to be different to Killian Jones felt good.
“So, when people ask me what my best friend does for a living…”  
Just when Emma thought that his smile couldn’t get wider, he proved her wrong with a grin that sent butterflies to her stomach.
“You tell them he’s a professional cuddler. Trust me, the reactions are priceless.”
* * *
Life with Emma Swan was great.  
It was what they both needed: something reliable, something familiar and routine. They spent their time together at his apartment because Killian, I’m poor and my apartment is the size of a walk-in closet. And when he wasn’t convinced - Fine, it’s because you have that fantastic bean bag that I would give my left kidney for.  
She always brought food, whether a full meal from that surprisingly good chinese place down a few blocks, or just a few brown bags of groceries. Somehow they always ended up tangled up together, watching YouTube videos or one of those Netflix series which can’t actually be that good, and turns out an all-time favorite.  
Sometimes he played guitar while she chopped vegetables in the kitchen. And other times she added songs to their joint Spotify playlist (appropriately named “untitled” because Emma wouldn’t allow any of the other ridiculous names he’d suggested) that she just knew he’d be playing on repeat for the next week.
And when he was having a really shitty day, she brought Captain Morgan. That was how he knew she was his best friend. He didn’t even have to say anything, the bottle would already be in his hands.
It had been eight months since their unlikely friendship began. Had it not been for his constant stream of clients - who valued their privacy - in and out of the apartment, he’d have already asked her to move in. Once Killian’s last appointment ended for the day, she was there and really only ever went home to sleep.
“Just because you live somewhere doesn’t make it home, Killian. My apartment is like living in a graveyard. There’s no life. At least your apartment has ferns.”
“Aye, love, well I’m glad my ferns keep you coming every day.” His chest tightened as he wondered where exactly she considered home to be. If he had any other job, he could just allow her permanently into his life, whatever that meant. Instead, Emma would continue to pay her rent and sleep in her own bed, but eat her meals at his table.  
“Can I schedule another appointment?” she asked through a mouthful of fried rice, chopsticks digging around the white take out carton hidden shrimp. Killian blinked a few times.
“Did something happen at work?” Emma shrugged, not in the mood to elaborate. Lately, it wasn’t often that she kept things to herself. He was glad to help her, though, even if it was as a professional before it was as a friend. Finally he said, “Yes, I have openings, but I’m not going to ask you to pay me. That’d be ridiculous.”  
“Why? If you were an artist, and I wanted you to paint something for me, you’d still ask for a commission. You’re a businessman who has to work for a living.”
“Oh, now you’re making me sound like a white-collar.” He paused for a second. “You’re adamant about this?” If she wanted to hire him once more, then who was he to deny her?
“Alright, love. How’s Wednesday at noon?”  
* * *
It began like it always did, Emma standing in front of his apartment dressed in comfortable clothes. Her fingers tapped mindlessly against her hip while she fought the urge to check her watch for the fourth time.  
It felt almost the same way it did that first appointment when she didn’t know who he was or what to expect. But this was Killian, her best friend of all people! He was the most predictable thing in her life, the one who never expected more than she could give, the one who always could read her as easily as one of the books on his shelf. When she was wrapped in his arms, there was no place in the world that was safer.  
That was all she’d ever wanted since she was a little girl, and she had long since given up hope that she would ever find it. But it had happened, after almost twenty-eight years it had finally happened.
She couldn’t even thoroughly enjoy it because she was falling in love with him. Emma scoffed. Who was she kidding? The falling had already happened. The falling had sent her plummeting toward over a cliff where she crash landed, head way over her heels.
Emma couldn’t help it, she glanced down at her watch and saw that he was thirteen minutes past noon. She frowned. Killian always had his clients in and out very promptly, and she was positive he was supposed to have someone in there with him. Tugging at the bottom of her sweater, Emma decided to wait for a few more minutes.
Five minutes passed and no one exited the apartment. Killian hadn’t even gone out to check to see if she was there, so she knocked lightly. The next moments were agonizing, the anticipation of seeing him making it difficult to breathe. But he never came. She checked to make sure she had the right apartment - of course she did, she practically lived here- and that she had no messages on her phone. Trying the handle, Emma discovered the apartment was open. First she peeked in to see if Killian had just lost track of time with a client on the beanbag, but the apartment was empty.
“Killian?” she called out. Entering the apartment, she dropped her purse and keys on the counter. “Killian, are you home?”  
No response. Okay, that was different. Killian was always home to be available for potential walk-ins. Emma padded through the apartment, noticing the minute differences in its condition. There were dishes in the sink, a half full mug of cold coffee beside the stove, and a dirty plate sitting on the end table beside the couch. Killian was never the type not to not pick up after himself.
She searched the apartment for signs of him, but he wasn’t in his bathroom or in his bedroom. Just as she pulled out her phone to call him, she heard a cough from outside the window.  
What was he doing on the fire escape?
Emma peered out of the open window and found him sitting on one of the metal stairs, a flask at his lips.  
“I’ve never known to you do drink,” she called out.
Killian’s head snapped down at her and for a second his eyes looked right through her, dazed and confused. Reality dawned on him as the fog in his gaze cleared. With a quick glance at his watch, he groaned.  
“Gods, Swan, I totally forgot. I’ll make it up to you, I promise.” It wasn’t just an apology, Emma noticed. It had an unsettling amount of self-loathing and grief. Emma leaned over the windowsill, letting the cool fall breeze cut through her hair. “Just maybe not today.”
“Are you alright?” she asked. His response was an ashamed look at his flask. “Mind if I come up, then?”
Killian shook his head.
Emma settled herself just below him, sitting parallel to the stair with her knees to her chest. Killian mirrored the way she sat so that he could look at her.
“So, are you going to tell me what’s wrong?” she asked. His fingers fidgeted around the curve of the flask.
“I saw something earlier that reminded me of my brother,” he stated simply, if not a bit sad. Emma blinked, attempting to keep hide her surprise.
“I didn’t know you have a brother.”
Now that she thought about it, Emma knew next to nothing about his family. She’d never asked before to avoid answering any questions about her own family, but it was different now. She was ready to open up if he was.
“His name was Liam,” Killian finally admitted quietly. “He was the man who raised me, the one who fed me and sent me to school each day. But he was my role model too. Everything I learned about being an honorable man, he taught me.”
“What happened?” Emma asked. The muscles in his jaw clenched, the tension making his hand clench around the flask. When his sea blue eyes began to glisten, she wondered if maybe she shouldn’t have asked at all.
“He passed away,” he stated simply. “A boat accident five years ago. He was supposed to be repairing it, but there was a gas leak. The engine sparked and well…Anyways, there was an incident down at the harbor last night and when I saw it on the news, I guess I realized I wasn’t entirely done grieving.”
Emma waited as he took a swig of the rum and let the alcohol ease the ache of remembering. She didn’t know what to say. Her own experience with tragedy made her sure that he didn’t want any pity, but she didn’t want to discount the strength it took to talk about it.
“You’re an amazing man, Killian Jones,” she finally said. The warmth in her eyes matched her sweet tone, and Emma hoped it told him just how proud she was of him. “This world is a brighter place with you in it.”
Then she leaned her head on his knee, stroking his hand with a soft touch. Killian remained silent, letting the atmosphere between them whisper all the things he couldn’t say to her. The shaky squeeze of his hand said thank you, the tiny smile on his lips hummed I’m a better man when I’m with you, and his tender gaze spoke the message that he hoped she couldn’t hear. I’m falling in love with you.
Emma didn’t stay for her appointment. Instead, she turned on his favorite music, warmed up some leftover mac and cheese, and let him spend the rest of the night with himself. He was thankful. Any other time he would’ve wanted her to stay, but this last ounce of healing was something he needed to do alone.
Besides, if he needed her, she’d only be a phone call away.
* * *
Two days went by before Emma heard from him again. She had just woken up, her hair still a mess atop her head and a steaming coffee in hand, when her phone buzzed.
Killian [8:47am] - My apartment, 5pm, come hungry.
Killian [8:47am] - This is a real appointment, but don’t even think about paying. I owe you one.
Emma [8:49am] - Sounds like I’m seeing my best friend AND a professional cuddlist tonight. I’ll be there.
She was three minutes late to knocking on the door. From the hallway she could smell the aroma of something sweet in the oven, traces of cinnamon and apple reaching her senses. When the door swung open, she was greeted by a Killian Jones who looked like his few days alone had done him some good. There was a new life in his eyes, an excitement to go through with whatever he had planned for her.
“Sorry I’m late,” she said casually when he was frozen in the doorframe with a grin.
“Nonsense, we’ve all evening. Come on in.”  
“How would you like to start, Master Cuddler?” Emma asked, starting to feel her nerves prickle in anticipation as he rushed into action.
“You can start by getting comfortable. Is a massage okay with you?” he asked, his voice taking the warm tonality of his professional self. When she nodded, he laid some soft towels across the couch. “I don’t really have a massage table, but I hear the couch works just as well.”
Standing across from him not knowing quite what to do, Emma crossed her arms in front of her and watched as he pulled a basket of candles from the cupboard. She’d never gotten a massage from him before, only at fancy spa getaways (which were also gifts from her mother). Unlike the other places she’d been, she didn’t plan on stripping out of all of her clothes. Instead, she pulled off her sweater, leaving her in her leggings and cami.
“I need to go grab a few things, but you can lay down on your stomach and get cozy.”  
Emma did as she was told, feeling her body relax into the soft cushions of his couch. Her mind, on the other hand, raced at a million miles a minute. Had she known he planned for a massage, she definitely wouldn’t have agreed to coming tonight. How could she ask him to touch her in a borderline intimate way when she was developing feelings for him? Before now, she’d been good about hiding her romantic affections, especially from herself.
Folding her arms under her chin, Emma frowned. This was a doomed situation if she ever heard of one. She should probably just run while she has the chance.
Killian came back before  the instinct to flee could grow too strong. There was a bounce in his step, like he was excited to do this with her for real. At the very least, the melancholy from earlier seemed to have faded. She watched as he lit candles, plugged in the space heater, and pressed play on his stereo.
“Are you alright, love?”
Emma bit the inside of her cheek. Was she that transparent?  
“Yeah, why?” Killian didn’t answer. He simply knelt in front of her and brushed some hair out of her face.
“Just checking,” he said gingerly. “As always, stop me if you get uncomfortable. It’s just a basic massage, though. No funny business.”
Emma would’ve chuckled, but as he settled into position, the only thing her brain could process was his comforting smile. Killian instructed to relax her arms so that they settled at her sides. With one last confirmation of her consent, he began his work.
The silence between them was comfortable, filled with the hum of ambient electronic instrumental music. She could tell Killian was in full concentration mode as he worked, rubbing his hands together so that the friction would warm them up.
Killian started with her feet. He’d given her foot massages before, but not quite like this. His hands pressed into the soles of her feet slowly, urging the tension to release and relax the muscles. The nerves all over her body vibrated even though his focus was latched onto rubbing her feet. Chills erupted up her leg when his hands moved to knead her calves, each slow pull of his hands completely unwinding her.
As his hands worked into her leg muscles and nerves, Emma felt the passage of time slow to a halt. It was the first time in years she’d felt so at peace, so safe and well-taken care of. When he was sure all the tension in her legs was gone, he trailed his palms up to her spine where he massaged her unhurried and tender. Smooth palms over her back alternated with his fingernails as he scratched in gentle circles.  
Emma bit her lip to keep from vocalizing how marvelous she felt. But it wasn’t just the massage itself. He caressed her with such reverence, as if she were precious treasure in his hands. All she wanted was for this to continue forever, to always be free to feel his worshipping hands on her skin, to hear his breath in her ear. She wanted it indefinitely.  
And that scared the hell out of her.  
There were many things she expected to feel during this, but fear wasn’t one of them. Shouldn’t she have felt glad that he cared for her, respected her? After all, he was the only person she’d met in a long time who wanted to do something like this for her.  
“Are you alright?” he asked, noticing how she seemed to have tensed up. She hummed in response, unable to lie to him. But he knew her well, and he removed his hands, and instructed her kindly to “Sit up, love.”
She complied, hands folding nervously in her lap.
“Can I keep going?” he asked.
“Of course! But only if you want to.” He frowned, and she was quick to explain herself. “I wasn’t sure if I did something wrong or-”
“No! Never. I was wondering, myself, if I had done something to make you uncomfortable.” He was so good to her, always paying such detailed attention to her reactions.  
“Killian, I’m fine. This has probably shaved ten years of stress off of me.”
He began again, this time closer. With her sitting up, he had better access to her shoulders. Warm puffs of his breath ghosted her neck as he dug his fingers into her shoulder blades. His touch emitted even more veneration than before, as if his concentration was well honed to perform his best work.
When his fingers reached her hair, she leaned back into his touch. The man was too talented for his own good, fingernails scratching along her scalp bringing sensations that distracted her from her fears. She could feel his chest pressed against her back, the rise and fall of his chest as he breathed calming her down.
His touch began to slow, becoming fainter as he brought the massage to a close. Emma sat frozen, unsure if he was really finished, because his hands still rested on her shoulder.  
The next events passed like a hazy vision, her mind blurry with fogginess, but nerves aware of every touch.  
There was silence, and then his lips pressed against her shoulder. Emma turned rigid the same second he did, both of them stunned into stillness. Killian immediately pulled his hands off of her, swallowing as he skirted a few inches away from her. Emma turned and sucked in a breath of air. He was closer than she thought, far enough away to give her space to breathe, close enough that he was within reaching distance.  
The spot on her shoulder he had kissed still burned sweet, and she craved more. This was new territory, ground they hadn’t traveled yet. He was just Killian now, the professional cuddler dissolving as desire filled his eyes. Just as she was about to reach for him , he leaned forward and took her cheek in one of his palms.
Killian opened his mouth to say something, but the words wouldn’t come. They hung in the intensity of his eyes, their meaning just out of reach. Maybe she didn’t know about him, but Emma knew what she wanted. She tilted forward just a fraction, the movement so slight she doubted he noticed it.
Something in his gaze sparked, and that was it.
Before she could register the decision on his face, he was kissing her. Emma’s mind numbed of all sense and awareness, overwhelmed by the soft way his lips were pressed to hers. He tasted sweet, like refuge and acceptance. Her hands grasped at his shirt, seeking an anchor.
When she lifted her arms around his neck, the kiss dissolved into a search for the other’s touch, needing to soothe the ache to bring the other closer.
And just when she was starting to think that she could do this forever - kiss him, hold him - a voice spoke to her loud enough that she could hear it over the roaring in her ears. He’s using you. Emma kissed Killian harder, as if the intensity would hinder her walls from rising. Just wait. He’s not going to want you after this.
Right on cue, Killian tore away.  
He looked as stunned as she felt, chest heaving, cheeks flushed.
“That was a mistake,” he murmured, shooting to his feet and clenching his fists. “A really bad mistake. I shouldn’t have even considered-”  
Emma stared at him, utterly horrified. Was it that bad? Was it so appalling to even consider wanting her?
“I’ve gone three years without the thought even crossing my mind, much less acted on it,” he rambled, pacing across the floor. “But this….you…”  
The man was unraveling and she was the cause. Maybe that was what she wanted, but not like this.
Suddenly, Killian’s pacing halted. He took a fortifying breath before turning to look at her with a composure that meant that the professional was back, masking what he was really feeling.
“That was completely, utterly inappropriate and I am so sorry.”
“No, I’m the one that’s sorry. I put you in this weird position by scheduling an appointment and then I gave into the moment.” Killian shook his head, like the fact that she was feeling guilty was something he wanted to extinguish. “I just really, really don’t want this to ruin your career.”  
He heard the silent or our friendship.
And out of all the things he could’ve said, she wasn’t surprised when he murmured in a quiet voice, “I hope you’ll understand when I tell you that I can’t accept you as one of my clients anymore.”  
Emma expected as much, but it still ached to her core to hear the words spoken aloud. He wanted nothing to do with her, and she was senseless and shortsighted to think that anything would change.  
But she wasn’t going to let him see her cry, so she rose to her feet, grabbed her shirt, and headed toward the door.  
“Where are you going?” he called out, voice rough.
“You’re absolutely right, Killian. About all of it,” she said weakly. “I should probably just go.”
Killian’s blood ran cold as he got the slightest feeling that when she vanished out of his front door, she was leaving for good.
* * *
226 notes · View notes
teabunnie · 5 years
Text
I had a lot of mental health issues as a kid. I had sensory issues, an absolute need to fidget and make weird noises, (I vividly remember being publicly shamed by a teacher in this grade for making a NOISE) hallucinations and probably more. The hallucinations and paranoia peaked in my early teens and then just STOPPED. I never spoke to anyone about them even when they were very difficult to deal with because I was a secretive child.
As I got older I was mostly curious about this, but sometimes I worried they would come back. Every few years I see a figure out of the corner of my eye that's not really there and I panic, thinking I'm about to start having hallucinations regularly. I don't.
I have always been very careful to hide my feelings. Almost a decade ago, after something reminded me of an abusive relationship I was incapacitated for a few days. When I tried to force myself to go back to college to avoid failing a class with a strict attendance policy I wrecked my car. My mom saw through me and (correctly) told me I should see a therapist. I started trying to find one.
I called the hotline my mom gave me that was linked to our insurance. I had to answer a long list of prying questions before being emailed a list of providers. I don't remember what was wrong with the first list, but something wasn't right and I had to call back. They told me they needed me to go through the list of questions again. I hated it. I cried. I did it. I wanted help. I was emailed another list of providers. I called one of the providers. They were confused. "You want to make an appointment for yourself?" "Yes." "How old are you?" I was given a list of providers for children. The person at the hotline assumed I was a child without asking, probably because of my voice. I couldn't bring myself to call the hotline a third time. I don't think I could bring myself to tell my mom what had happened.
I'm not sure how long after that I decided to talk to my primary care physician. I told him I was having panic attacks. He tried to prescribe me an SSRI. I was (and am) convinced for a number of reasons that this will not help me. He prescribed me a low dose benzodiazepine as needed. This helped when I took it, but I rarely took it when I needed it because I felt bad about it for one reason or another.
The next year at my appointment he had me fill out a depression survey thing. I didn't think my answers were really dramatic or scary. He did. He tried to convince me to take an SSRI. I told him I wouldn't. He told me that if I asked for a refill on my benzos too soon he would insist. Okay. Another reason not to take them when I needed them. I told him I wanted to see a psychiatrist. I had decided that I specifically wanted to see someone who could make a diagnosis and provide appropriate medication if necessary. In addition to an anxiety disorder I was beginning to suspect that I was on the spectrum. I didn't want a therapist. If I went to a therapist I wanted them to be recommended by a phychiatrist. He gave me a list and personally recommended two people on the list.
I called the first person. They weren't accepting new patients. I called the second person. They weren't accepting new patients, but said they could set me up with someone else in their office. Good enough for me. Let's do it.
After making it to the appointment I realized that they had set me up an appointment with a therapist. Someone who couldn't diagnose me. Someone who couldn't prescribe medication. I decided to make the most of it.
The therapist I saw asked all the wrong questions. She wanted to know what was currently affecting me that day. She told me some things I already knew about panic attacks. She told me that everything I panicked about was something totally reasonable to be upset about, but she said it in a way that made it seem like I didn't have panic attacks. She would get off topic and talk to me about her other patients a lot. I got nothing out of my appointments, but I was so determined to. I tried so hard to be hopeful. I kept going. I spent a few hundred dollars on these appointments. On my last visit she made a sexist comment. There was my breaking point. I felt intensely discouraged. I had a lot going on in my life and I decided to try again later.
My mental health declined and with this came intense stomach and chest pain. I threw up a few times. This had never happened to me before. I went to see my doctor and he checked me for everything he could think of. He could see that I was in terrible shape and he looked genuinely, intensely concerned. He looked defeated when it wasn't the first few things he thought it might be. I asked him if it could possibly be anxiety. He said he really didn't think so. I broke down sobbing and told him about all the things that were worrying me at the time. He was taken aback and said that it might really be anxiety. He told me that I should take my benzos just a little more often when I need them. I was buying a house and we both knew this was probably the last time I would see him.
I moved to the country and my mental health was ever deteriorating. I needed to find help. I found a new primary care physician and asked him for help finding a psychiatrist in the area. He said he was sure there weren't any in the area, and basically that I was on my own finding one.
I tried Google. I called the nearest mental health center. The secretary directed me to a number that went straight to voicemail. I recieved a call back 4 days later where a man left me a voicemail saying to just call back. I did and got the same man on the line. (Same name! Same voice!) He said that he was NOT the person to talk to and he didn't know why I was calling him (less than 24 hours after responding to my initial call) after a lot of yelling about how he didn't understand the new phone system, he directed me to the director of something or other. I tried to explain my situation and she first implied that I was looking for abusable drugs, then said over and over that they couldn't help me because it didn't sound like I had a "serious" mental health problem. Then she said she couldn't help me because of the county I live in. She listed the four counties her office serves, which included my county. I don't know what to say about any of this. I don't remenber what I said. Probably "okay." She told me to call my insurance company.
I eventually worked up the nerve to call my insurance company's mental health hotline. It was a fully automated system. There was no option to speak to a person. I asked for providers within 50 miles. I couldn't understand the name of the provider. I asked for it to be spelled, but I still couldn't understand. Then it glitched and hung up on me. I called back and got the name of the provider. Then it said that was the end of the list. One provider within 50 miles. I googled the phone number and it was another branch of the mental health center I called before. I didn't like that, but I called. The secretary gave me the number of their "income specialist" or something. I called. It was an automatic, always leave a voicemail thing. No chance of getting a person on the phone. I left a voicemail and cried. A week went by and they didn't call. I was too tired to keep trying. I cried a lot. I figured I'd try again in a few months maybe. Maybe.
After two weeks the income specialist called me back. She spoke to me for a while, and though she was kinder about it than the director, she told me she couldn't help me because it didn't sound like I had a serious mental health disorder and I didn't have a caseworker. She asked me the name of the provider the insurance company gave me. It was a unique name. She told me that that person worked there, but they were not a mental health provider and certainly not a doctor. I had already had so many issues with my insurance company at this point that I was hardly surprised. She recommended a psychiatrist in Farmville, a little over an hour away from my house. She said she knew they were accepting new patients. I thanked her.
It took me a while to find the energy to call this psychiatrist. Her secretary seemed confused, and said she would have to check if the doctor was taking appointments and call me back. I said that I was told she was. She insisted that she would have to call me back. She had all my information. A week later I had not recieved a call back. I called again. The answering secretary confirmed that the other secretary must have forgotten about me entirely. She said that there was a long wait list, 3-4 months, but if that was okay she would add me. I agreed. I figured if I've waited this long, I could wait a few more months.
After finally getting on a wait list, my mental health just got worse and worse. I'm in physical pain almost every day. I can't concentrate. I'm doing poorly at work. Sometimes I can't remember to shower for 4 days. I forget what I'm saying mid-sentence. I cry a lot. My stomach is always upset. In the past few days I've had insomnia like never before. I feel like my fiance is having to take care of me like a child. They act like they don't mind, but I do. I want to be helpful. I don't feel helpful most days.
I have always known that my panic attacks are completely different if I'm at work versus if I'm at home. I've been thinking about all the ways in which they are different. And about how recently I seem to completely shut down, unable to think or speak. After some research I think some of my panic attacks aren't panic attacks, but autistic meltdowns. I hoped learning about this would make me feel better, but I just feel hopeless. I want to see a doctor. I'm scared I'll finally see a doctor and they'll be shitty or not have any expertise on autism. I don't have the energy to keep looking. I barely have the energy to get up in the morning. I just don't know what to do.
5 notes · View notes
nancygduarteus · 7 years
Text
Therapy for Everybody
JOHNSON CITY, Tennessee—The first patient of the morning had been working 119 hours a week. Greta (not her real name) had been coming home late at night, skipping dinner, and crashing into bed. One recent night, her college-aged daughter melted down, telling an exhausted Greta that her parents’ marital tensions were putting a strain on her.
“She’s like, ‘Why don’t you just divorce him?’” Greta recounted to her psychotherapist, Thomas Bishop, who was perched on a rolling stool in the bright examination room. “‘Why don’t you just do it and get it over with?’” Greta planned to stay with her husband, but her daughter’s outburst worried her. “Is this going to affect the way she feels about relationships?” she asked Bishop.
Listen to the audio version of this article:
Download the Audm app for your iPhone to listen to more titles.
Though it was just 14 minutes into the therapy session, and Greta had only seen him a few times, Bishop tried his best to interpret the daughter’s feelings. “There’s a period developmentally where we kind of look and go, ‘Gosh, I wish mom and dad were this way,’” he explained. Later, in their 30s, people realize their parents “are what they are,” he added.
“So this is her struggle, not your struggle,” Bishop told Greta, reassuringly. He wrapped up with some practical tips, urging Greta to compartmentalize her work and life issues, perhaps by journaling or taking a different route home from work.
Greta seemed genuinely pleased as Bishop swept out of the exam room. Her therapy session had lasted just 20 minutes.
Two weeks prior, Greta had walked into the clinic, a family-medicine practice situated on the campus of East Tennessee State University, hoping to see a primary-care doctor because she was so stressed she could barely function. When the receptionist initially told her, because of a miscommunication, that it would take a month to be seen, Greta cried, “I’ll be dead by then!” She was seen that day. After a medical resident finished evaluating her physically, he called in Bishop, the psychotherapist.
Bishop is part of a unique new breed of psychologists who plant themselves directly in medical offices. In clinics like ETSU’s, the therapists eschew the familiar couch-and-office setup. Instead, they pop right into in-progress medical appointments and deliver a few minutes of blitz psychotherapy. (ETSU allowed me to visit the clinic and sit in on patient visits as long as I did not disclose their real names or identifying details.)
Exploring one’s demons by the 50-minute hour might be a relatively common practice in large cities, but ETSU’s clinic is situated in the thick of Appalachia, where mental-health care is both less familiar and less accessible. Johnson City has recently witnessed an economic revival, with its brewery scene a modest tourism draw, but the surrounding region is still dotted with discount stores and unpainted shacks. Bishop’s patients bring him stories not only of family and marital strife, but also of financial pressures. If the trope is that psychologists help the “worried well,” this clinic helps the worn-out but hanging-in.
Also stationed in the clinic’s busy atrium that day was Jodi Polaha, a fellow psychologist, ETSU professor, and evangelist for this kind of therapy, which is called “integrated behavioral health care.” Along with providing therapy to patients, the clinic’s psychologists help train the clinic’s medical residents to employ their therapy techniques, which emphasize finding solutions. Some of the most common issues that send people to their primary-care doctors—like bellyaches and backaches—often don’t have clear physical causes. “It’s usually some lifestyle change that’s needed,” Polaha said. “That’s where we come in.”
Integrated psychologists can help patients manage their pain at home so they, for example, don’t run to the emergency room at the slightest twinge. One chronic-pain patient, who saw painkillers as the only way to ease her suffering, recently told Bishop that one of the residents gave her some of his “Buddha stuff”—relaxation exercises to do at home. Savings like these are especially important to the perennial American quest to cut health-care costs. An estimated 5 percent of the U.S. population accounts for 50 percent of all medical costs, and mood disorders are one of the most common conditions these high spenders suffer from. Some types of psychotherapy can make patients more likely to adhere to a doctor’s medical advice or to follow-through on weight-loss plans, saving a medical practice time and money in the long run.
The clinic charges uninsured people on an income-based sliding scale, and patients aren’t charged an extra co-pay if a therapist drops in on their medical visits.
Bishop, a 52-year-old who squints when he smiles, is the earnest one. (He frequently mentions that he has been married 31 years and has moved 20 times.) Polaha, who is 47 and looks like a nerdier Robin Wright, is more irreverent. One day during my visit, a clinic resident, Becca Sacora, approached Polaha to see if she wanted to check in on one of Sacora’s patients. “She’s a pretty sick lady,” Sacora said. “I’ve been putting out fires with her medical state. She’s 39 and has a severe history of anxiety and depression.”
“If you’re not busy,” Polaha responded, “it would be great if you could work with me on an introduction” to the patient. Then she added with a wink, “It’ll take two minutes of your time, and then you can go back to looking at Facebook or whatever you do all day.”
The next morning, I went on a pre-dawn hike in the Appalachian Mountains with Polaha and Bishop—grueling feats of athleticism being the preferred activity of these two middle-aged colleagues. Other days, Polaha does open-water swimming or weightlifting, and Bishop trains for one of his frequent marathons.
In the freezing dark, Polaha pulled on her headlamp and leapt into the air a few times: “Let’s get warmed up!”
“Exercise is stress management,” she assured me, as we trekked straight upward and snot ran down my face.
Polaha, who grew up near Philadelphia, got into rural medicine as a grad student at Auburn University in Alabama, where she treated poor, troubled kids. Some of the kids didn’t have running water, and they gave her head lice, but she loved feeling needed. She went on to practice pediatric psychology in Nebraska, traveling around the state to help kids whose developmental or emotional problems were too severe for their small-town doctors to fix. Once a week, she would work with primary-care doctors in a town called Hastings, staying at a Comfort Inn. When she left that job, the Comfort Inn threw her a going-away party.
Polaha and her husband moved to Johnson City in 2006. At the time, Bishop was already practicing integrated care in a nearby town. He’s a northerner like Polaha, but his blue-collar past helps him relate to his patients, a quarter of whom are on Medicaid. Bishop spent his childhood in Flint, Michigan, helping raise his own younger brothers and sisters after his parents divorced. The experience made him embrace chaotic environments, like that of the juvenile offenders he worked with in Michigan.
Integrated care helps solve a lot of the problems with more traditional forms of psychotherapy—like getting to a therapist, which can be impossible for many Americans. About half of U.S. counties don’t have any mental-health providers, and about a third of psychotherapists don’t accept insurance at all. An hour is a long time to take out of one’s workday, so many patients don’t show up to psychologist appointments, even when they’re referred by their regular doctor. “Physicians used to call us black holes,” Polaha explained.
By offloading mental concerns to an on-site psychologist, the primary-care doctors’ time is freed up. Doctors can see more patients, so the clinic makes more money, which can be used to pay the psychologist.
There aren’t clear numbers on how many primary-care practices in the U.S. are integrated to ETSU’s extent, but one study found 23 percent of rural primary-care practices, and 40 percent of urban ones, have a mental-health provider onsite. In many cases, though, “integrated” just means the two providers have offices in the same building.
When Polaha arrived in Tennessee, she heard about Bishop’s work and persuaded him to join the university’s medical school. Eventually, they opened up the integrated practice together. Today, Polaha splits her time between clinical work, research, and teaching. “Since he’s been here, we’ve been able to do even more,” Polaha explained as we hiked, not even straining to keep up her rapid-fire speech. “Plus [we] have time to go hiking.”
At the clinic, a resident pulled Bishop into another room, this time to speak to a patient who had cycled through several antidepressants, ADHD drugs, and sedatives. Now, she was asking her primary-care doctor about getting on a new stimulant drug to help her focus at her new job.
This is fairly common: Primary-care doctors, for instance, are the ones who prescribe the bulk of the antidepressants that Americans gobble down. In most cases, they do so without diagnosing the patient with any clear psychiatric problem.
Meanwhile, typical primary care often fails to catch mental-health issues in people who don’t know they have them. The U.S. Preventative Services Task Force recommends that all American adults be screened for depression at primary-care doctors’ visits, but only 4 percent of primary-care appointments include this type of screening. Normal primary-care doctors may feel too busy or ill-equipped to provide mental-health care without a psychologist present, or they may not be able to bill insurance for it. “I went to the minute clinic this weekend because I was afraid I had an ear infection,” Charles Ingoglia, a senior vice president at the National Council for Behavioral Health, told me. “In the course of talking to the [nurse practitioner], she indicated that she would not feel comfortable screening for depression, as she has no resources to do anything about it if a screen was positive.” In other words, she needs a Tom or Jodi.
“If I don’t keep it together at work, I’m going to lose my job,” said Bishop’s patient, a 30-something mom and bill collector. “It’s the highest-paying job that I’ve ever had.” Bishop asked her about her childhood, figuring that any signs of ADHD would have emerged when she was young. Growing up was just “eh,” she said. “My mom was very strict, very ... judgmental.”
“Did you do any counseling or anything when you were young?” Bishop asked.
“No. My mom doesn’t believe in it,” she responded, her voice breaking.
In her new job, “there’s no room for error,” Jane said. But she doubts herself constantly. Her manager scolds her, then wonders why she second-guesses herself. “She reminds me of my mom a little bit,” Jane said.
Jane dropped out of college twice. She knew she could do the work, but every time she stepped foot on campus, she had an anxiety attack. By the time she got to class, “my heart would be palpitating so fast that I wouldn’t even be able to hear the teacher.”
“I’m not completely convinced that this is ADHD,” Bishop told her. And given her anxiety levels, he said, he didn’t want her to take more stimulants. Before leaving the room, Bishop suggested she also meet, for no extra charge, with the health coach—one the clinic also employs—to help her lose weight and drink less.
“You’re awesome!” Bishop said. The woman chuckled a bit as she wiped her tears.
The week before I visited, there was a hate crime in Polaha’s neighborhood. Someone threw a dismembered cow carcass in the yard of a woman who had decked out her house in gay-pride flags. They also scattered about 70 nails near her car.
The following Sunday, Polaha and her neighbors rallied around the woman, standing in the park and selling rainbow flags to raise money for LGBT causes. On top of the gay-rights activism, Polaha also sits on a committee of mothers concerned about gun violence and is part of a supper club devoted to discussing topics like philosophy and ethics. Her county, like the rest of Tennessee, overwhelmingly supported Donald Trump last November, but Polaha showed up to the polls in an all-white pantsuit and later helped organize the local Women’s March.
At the park fundraiser, Polaha explained to me an analogy she often uses to get patients to make small, incremental changes in their lives. Think of a target, she said, and think of the bull’s eye as representing your values. “If each thing you do all day long is throwing a dart at this target, where would you say your darts are landing?” Polaha asked. If your darts aren’t landing near your values, “What are some things you could do today? Tomorrow morning? This week?” Patients, she told me, will say things like, “I could take my dog for a walk,” or, “I could offer to drive my husband to work.” Before long, patients start to resemble the good mom or loving wife they envisioned at their target’s center.
I had seen Polaha use this technique at the clinic with an overwhelmed mom of twins. The woman had arrived weeping because her neighbor criticized her parenting skills, which she was already feeling insecure about. “It’s like a never-ending sleepover at my house,” the woman complained.
Polaha told the mom to imagine herself as a captain navigating a ship through a terrible squall. The mom had to choose between forging ahead to the other shore—that is, parenting her rambunctious kids the best she could—or retreating below deck to cognitively hide under some blankets. It might be more comfortable to seek cover from the gales of parenting, Polaha explained, but it would come at the expense of the twins’ health and development.
Watching her sell rainbow flags in a park in rural Tennessee, I asked Polaha whether it ever bothers her that her patients are, statistically, likelier to be Trump voters than not. I wondered how she, a woman who devotes much of her spare time to progressive causes, mentally digests the fact that her patients’ values, which she tries to get them to endorse more fervently, might be radically different from her own.
Polaha minimized the importance of political identity to a person’s overall value system. “Everybody, in their core,” she said, “wants kind of the same sorts of five or 10 things, right?”
Anyone who happened to spot a friend or neighbor walking into the ETSU clinic waiting room would never know whether they’re there to get their minds or bodies checked. That’s important, because stigma surrounds people with mental illnesses—as anyone who has ever had to explain a mid-workday jaunt to their therapist knows.
That stigma might be especially pronounced in areas where therapists are a foreign concept. For some Appalachians who suffer from depression or anxiety, “they’ll attribute it to ‘nerves,’” Miranda Waters, a psychometrist at West Virginia University Hospitals, told me. Waters grew up in Stearns, Kentucky, about three hours from Johnson City. The advice from locals, she told me, would often be: “Go to your doctor and get something for your nerves.”
Religion is a source of comfort and strength to many here. But a deep devotion to Christianity is viewed, by some, as a replacement for professional psychological help. “There’s a lot of ... thinking that, if you go to church, if you pray, if you’re faithful, you can get over a mental illness,” Waters said.
Several locals I met around town echoed this sentiment. One 63-year-old woman named Nancy, who was shopping at a nearby Walmart, swiftly told me, “No, no,” when I asked if people in the area get therapy. “We go to church,” she added. “We pray for the best.”
Compounding the cultural obstacles, there are only enough resources to treat four in 10 Tennesseans who need mental-health care, according to Marie Williams, the commissioner for the Tennessee Department of Mental Health and Substance Abuse Services. Appalachian cities have some social workers and master’s-level practitioners, but unlike in larger cities, there aren’t as many doctorate-level professionals who open up private practices here, Waters said.
To Polaha and Bishop, that’s precisely why their model can help in areas where people can’t or won’t get therapy otherwise. In one large study, elderly people were more likely to accept mental-health care at their primary-care doctors’ offices than at specialty mental-health clinics. In other words, if more primary-care providers embedded therapists into their practices, therapy could shed both its luxury status and its shame factor. It could become as ordinary and widespread as taking high-blood-pressure medications.
Bishop described a patient who came into the ETSU clinic recently and said, “I’m only here for my physicians’ assistant. There’s nothing you can do to help me.”
Bishop said, “You’re right, there’s nothing I can do to help you.”
That patient ended up coming to him for two years.
“Does everybody need psychotherapy? No,” Bishop said. “Could everyone benefit from psychotherapy? Probably.” Even Polaha once got therapy to overcome her public-speaking jitters—long after she’d already received her psychology doctorate.
With therapy so readily available, it might be hard for Bishop and Polaha’s patients to determine just how much therapy is enough—another struggle well-known to therapy-goers everywhere. Not unlike packing, therapy seems to take as much time as you have. Some studies show even one session of some types of therapy can help beat back depression, but the benefits of therapy tend to fizzle out as the number of sessions enters the double-digits. Bishop says a good therapist is a “mirror,” helping patients see their life goals more clearly, and reach them. Once you’ve achieved your goals, there’s little point in continuing.
I thought about my own therapy, which largely consists of me explaining the economic realities of journalism, over and over again, to a petite, middle-aged woman, after which she tells me to do more mindfulness exercises and charges me $170. “I wonder if I’ve been doing my therapy wrong,” I mused to Bishop during one quiet moment in the clinic.
“You’ve said that about four or five times in the last few days,” he said. “I think you should approach your therapist about that. I mean that sincerely.”
With his own patients, Bishop is sometimes the one who suggests it’s time to say goodbye. “I see myself working myself out of a job from day one,” he said.
At one point, it seemed like Bishop was trying to feel out whether one patient should still be coming to see him. She was a woman in her 50s, but she looked about 70, with a raspy voice and a tired expression, though she said she was feeling good. She had been seeing Bishop for years, talking about her struggle to quit smoking and a tessellating array of family issues. The woman spoke slowly and cautiously, in short sentences. At times, she sounded like she was answering a boring questionnaire rather than unburdening herself.
“Is it still helpful to meet?” Bishop asked finally.
“Yes,” she responded, to my surprise. She had been feeling more isolated from her friends than normal recently. “With me not being able to get to church, it’s nice to have a friend I can visit and talk with.”
Over the coming months, the woman did return to see Bishop several more times. But in the end, it was Bishop who announced he was moving on: He had accepted a new role at another university’s family-medicine center, where this coming year he will set up another integrated behavioral health practice. When Bishop offered to transfer her to a new therapist at ETSU, the woman declined. Even briskly efficient therapists, it seems, are too much like friends to be interchangeable.
from Health News And Updates https://www.theatlantic.com/health/archive/2017/06/therapy-for-everybody/531120/?utm_source=feed
0 notes
ionecoffman · 7 years
Text
Therapy for Everybody
JOHNSON CITY, Tennessee—The first patient of the morning had been working 119 hours a week. Greta (not her real name) had been coming home late at night, skipping dinner, and crashing into bed. One recent night, her college-aged daughter melted down, telling an exhausted Greta that her parents’ marital tensions were putting a strain on her.
“She’s like, ‘Why don’t you just divorce him?’” Greta recounted to her psychotherapist, Thomas Bishop, who was perched on a rolling stool in the bright examination room. “‘Why don’t you just do it and get it over with?’” Greta planned to stay with her husband, but her daughter’s outburst worried her. “Is this going to affect the way she feels about relationships?” she asked Bishop.
Though it was just 14 minutes into the therapy session, and Greta had only seen him a few times, Bishop tried his best to interpret the daughter’s feelings. “There’s a period developmentally where we kind of look and go, ‘Gosh, I wish mom and dad were this way,’” he explained. Later, in their 30s, people realize their parents “are what they are,” he added.
“So this is her struggle, not your struggle,” Bishop told Greta, reassuringly. He wrapped up with some practical tips, urging Greta to compartmentalize her work and life issues, perhaps by journaling or taking a different route home from work.
Greta seemed genuinely pleased as Bishop swept out of the exam room. Her therapy session had lasted just 20 minutes.
Two weeks prior, Greta had walked into the clinic, a family-medicine practice situated on the campus of East Tennessee State University, hoping to see a primary-care doctor because she was so stressed she could barely function. When the receptionist initially told her, because of a miscommunication, that it would take a month to be seen, Greta cried, “I’ll be dead by then!” She was seen that day. After a medical resident finished evaluating her physically, he called in Bishop, the psychotherapist.
Bishop is part of a unique new breed of psychologists who plant themselves directly in medical offices. In clinics like ETSU’s, the therapists eschew the familiar couch-and-office setup. Instead, they pop right into in-progress medical appointments and deliver a few minutes of blitz psychotherapy. (ETSU allowed me to visit the clinic and sit in on patient visits as long as I did not disclose their real names or identifying details.)
Exploring one’s demons by the 50-minute hour might be a relatively common practice in large cities, but ETSU’s clinic is situated in the thick of Appalachia, where mental-health care is both less familiar and less accessible. Johnson City has recently witnessed an economic revival, with its brewery scene a modest tourism draw, but the surrounding region is still dotted with discount stores and unpainted shacks. Bishop’s patients bring him stories not only of family and marital strife, but also of financial pressures. If the trope is that psychologists help the “worried well,” this clinic helps the worn-out but hanging-in.
Also stationed in the clinic’s busy atrium that day was Jodi Polaha, a fellow psychologist, ETSU professor, and evangelist for this kind of therapy, which is called “integrated behavioral health care.” Along with providing therapy to patients, the clinic’s psychologists help train the clinic’s medical residents to employ their therapy techniques, which emphasize finding solutions. Some of the most common issues that send people to their primary-care doctors—like bellyaches and backaches—often don’t have clear physical causes. “It’s usually some lifestyle change that’s needed,” Polaha said. “That’s where we come in.”
Integrated psychologists can help patients manage their pain at home so they, for example, don’t run to the emergency room at the slightest twinge. One chronic-pain patient, who saw painkillers as the only way to ease her suffering, recently told Bishop that one of the residents gave her some of his “Buddha stuff”—relaxation exercises to do at home. Savings like these are especially important to the perennial American quest to cut health-care costs. An estimated 5 percent of the U.S. population accounts for 50 percent of all medical costs, and mood disorders are one of the most common conditions these high spenders suffer from. Some types of psychotherapy can make patients more likely to adhere to a doctor’s medical advice or to follow-through on weight-loss plans, saving a medical practice time and money in the long run.
The clinic charges uninsured people on an income-based sliding scale, and patients aren’t charged an extra co-pay if a therapist drops in on their medical visits.
Bishop, a 52-year-old who squints when he smiles, is the earnest one. (He frequently mentions that he has been married 31 years and has moved 20 times.) Polaha, who is 47 and looks like a nerdier Robin Wright, is more irreverent. One day during my visit, a clinic resident, Becca Sacora, approached Polaha to see if she wanted to check in on one of Sacora’s patients. “She’s a pretty sick lady,” Sacora said. “I’ve been putting out fires with her medical state. She’s 39 and has a severe history of anxiety and depression.”
“If you’re not busy,” Polaha responded, “it would be great if you could work with me on an introduction” to the patient. Then she added with a wink, “It’ll take two minutes of your time, and then you can go back to looking at Facebook or whatever you do all day.”
The next morning, I went on a pre-dawn hike in the Appalachian Mountains with Polaha and Bishop—grueling feats of athleticism being the preferred activity of these two middle-aged colleagues. Other days, Polaha does open-water swimming or weightlifting, and Bishop trains for one of his frequent marathons.
In the freezing dark, Polaha pulled on her headlamp and leapt into the air a few times: “Let’s get warmed up!”
“Exercise is stress management,” she assured me, as we trekked straight upward and snot ran down my face.
Polaha, who grew up near Philadelphia, got into rural medicine as a grad student at Auburn University in Alabama, where she treated poor, troubled kids. Some of the kids didn’t have running water, and they gave her head lice, but she loved feeling needed. She went on to practice pediatric psychology in Nebraska, traveling around the state to help kids whose developmental or emotional problems were too severe for their small-town doctors to fix. Once a week, she would work with primary-care doctors in a town called Hastings, staying at a Comfort Inn. When she left that job, the Comfort Inn threw her a going-away party.
Polaha and her husband moved to Johnson City in 2006. At the time, Bishop was already practicing integrated care in a nearby town. He’s a northerner like Polaha, but his blue-collar past helps him relate to his patients, a quarter of whom are on Medicaid. Bishop spent his childhood in Flint, Michigan, helping raise his own younger brothers and sisters after his parents divorced. The experience made him embrace chaotic environments, like that of the juvenile offenders he worked with in Michigan.
Integrated care helps solve a lot of the problems with more traditional forms of psychotherapy—like getting to a therapist, which can be impossible for many Americans. About half of U.S. counties don’t have any mental-health providers, and about a third of psychotherapists don’t accept insurance at all. An hour is a long time to take out of one’s workday, so many patients don’t show up to psychologist appointments, even when they’re referred by their regular doctor. “Physicians used to call us black holes,” Polaha explained.
By offloading mental concerns to an on-site psychologist, the primary-care doctors’ time is freed up. Doctors can see more patients, so the clinic makes more money, which can be used to pay the psychologist.
There aren’t clear numbers on how many primary-care practices in the U.S. are integrated to ETSU’s extent, but one study found 23 percent of rural primary-care practices, and 40 percent of urban ones, have a mental-health provider onsite. In many cases, though, “integrated” just means the two providers have offices in the same building.
When Polaha arrived in Tennessee, she heard about Bishop’s work and persuaded him to join the university’s medical school. Eventually, they opened up the integrated practice together. Today, Polaha splits her time between clinical work, research, and teaching. “Since he’s been here, we’ve been able to do even more,” Polaha explained as we hiked, not even straining to keep up her rapid-fire speech. “Plus [we] have time to go hiking.”
At the clinic, a resident pulled Bishop into another room, this time to speak to a patient who had cycled through several antidepressants, ADHD drugs, and sedatives. Now, she was asking her primary-care doctor about getting on a new stimulant drug to help her focus at her new job.
This is fairly common: Primary-care doctors, for instance, are the ones who prescribe the bulk of the antidepressants that Americans gobble down. In most cases, they do so without diagnosing the patient with any clear psychiatric problem.
Meanwhile, typical primary care often fails to catch mental-health issues in people who don’t know they have them. The U.S. Preventative Services Task Force recommends that all American adults be screened for depression at primary-care doctors’ visits, but only 4 percent of primary-care appointments include this type of screening. Normal primary-care doctors may feel too busy or ill-equipped to provide mental-health care without a psychologist present, or they may not be able to bill insurance for it. “I went to the minute clinic this weekend because I was afraid I had an ear infection,” Charles Ingoglia, a senior vice president at the National Council for Behavioral Health, told me. “In the course of talking to the [nurse practitioner], she indicated that she would not feel comfortable screening for depression, as she has no resources to do anything about it if a screen was positive.” In other words, she needs a Tom or Jodi.
“If I don’t keep it together at work, I’m going to lose my job,” said Bishop’s patient, a 30-something mom and bill collector. “It’s the highest-paying job that I’ve ever had.” Bishop asked her about her childhood, figuring that any signs of ADHD would have emerged when she was young. Growing up was just “eh,” she said. “My mom was very strict, very ... judgmental.”
“Did you do any counseling or anything when you were young?” Bishop asked.
“No. My mom doesn’t believe in it,” she responded, her voice breaking.
In her new job, “there’s no room for error,” Jane said. But she doubts herself constantly. Her manager scolds her, then wonders why she second-guesses herself. “She reminds me of my mom a little bit,” Jane said.
Jane dropped out of college twice. She knew she could do the work, but every time she stepped foot on campus, she had an anxiety attack. By the time she got to class, “my heart would be palpitating so fast that I wouldn’t even be able to hear the teacher.”
“I’m not completely convinced that this is ADHD,” Bishop told her. And given her anxiety levels, he said, he didn’t want her to take more stimulants. Before leaving the room, Bishop suggested she also meet, for no extra charge, with the health coach—one the clinic also employs—to help her lose weight and drink less.
“You’re awesome!” Bishop said. The woman chuckled a bit as she wiped her tears.
The week before I visited, there was a hate crime in Polaha’s neighborhood. Someone threw a dismembered cow carcass in the yard of a woman who had decked out her house in gay-pride flags. They also scattered about 70 nails near her car.
The following Sunday, Polaha and her neighbors rallied around the woman, standing in the park and selling rainbow flags to raise money for LGBT causes. On top of the gay-rights activism, Polaha also sits on a committee of mothers concerned about gun violence and is part of a supper club devoted to discussing topics like philosophy and ethics. Her county, like the rest of Tennessee, overwhelmingly supported Donald Trump last November, but Polaha showed up to the polls in an all-white pantsuit and later helped organize the local Women’s March.
At the park fundraiser, Polaha explained to me an analogy she often uses to get patients to make small, incremental changes in their lives. Think of a target, she said, and think of the bull’s eye as representing your values. “If each thing you do all day long is throwing a dart at this target, where would you say your darts are landing?” Polaha asked. If your darts aren’t landing near your values, “What are some things you could do today? Tomorrow morning? This week?” Patients, she told me, will say things like, “I could take my dog for a walk,” or, “I could offer to drive my husband to work.” Before long, patients start to resemble the good mom or loving wife they envisioned at their target’s center.
I had seen Polaha use this technique at the clinic with an overwhelmed mom of twins. The woman had arrived weeping because her neighbor criticized her parenting skills, which she was already feeling insecure about. “It’s like a never-ending sleepover at my house,” the woman complained.
Polaha told the mom to imagine herself as a captain navigating a ship through a terrible squall. The mom had to choose between forging ahead to the other shore—that is, parenting her rambunctious kids the best she could—or retreating below deck to cognitively hide under some blankets. It might be more comfortable to seek cover from the gales of parenting, Polaha explained, but it would come at the expense of the twins’ health and development.
Watching her sell rainbow flags in a park in rural Tennessee, I asked Polaha whether it ever bothers her that her patients are, statistically, likelier to be Trump voters than not. I wondered how she, a woman who devotes much of her spare time to progressive causes, mentally digests the fact that her patients’ values, which she tries to get them to endorse more fervently, might be radically different from her own.
Polaha minimized the importance of political identity to a person’s overall value system. “Everybody, in their core,” she said, “wants kind of the same sorts of five or 10 things, right?”
Anyone who happened to spot a friend or neighbor walking into the ETSU clinic waiting room would never know whether they’re there to get their minds or bodies checked. That’s important, because stigma surrounds people with mental illnesses—as anyone who has ever had to explain a mid-workday jaunt to their therapist knows.
That stigma might be especially pronounced in areas where therapists are a foreign concept. For some Appalachians who suffer from depression or anxiety, “they’ll attribute it to ‘nerves,’” Miranda Waters, a psychometrist at West Virginia University Hospitals, told me. Waters grew up in Stearns, Kentucky, about three hours from Johnson City. The advice from locals, she told me, would often be: “Go to your doctor and get something for your nerves.”
Religion is a source of comfort and strength to many here. But a deep devotion to Christianity is viewed, by some, as a replacement for professional psychological help. “There’s a lot of ... thinking that, if you go to church, if you pray, if you’re faithful, you can get over a mental illness,” Waters said.
Several locals I met around town echoed this sentiment. One 63-year-old woman named Nancy, who was shopping at a nearby Walmart, swiftly told me, “No, no,” when I asked if people in the area get therapy. “We go to church,” she added. “We pray for the best.”
Compounding the cultural obstacles, there are only enough resources to treat four in 10 Tennesseans who need mental-health care, according to Marie Williams, the commissioner for the Tennessee Department of Mental Health and Substance Abuse Services. Appalachian cities have some social workers and master’s-level practitioners, but unlike in larger cities, there aren’t as many doctorate-level professionals who open up private practices here, Waters said.
To Polaha and Bishop, that’s precisely why their model can help in areas where people can’t or won’t get therapy otherwise. In one large study, elderly people were more likely to accept mental-health care at their primary-care doctors’ offices than at specialty mental-health clinics. In other words, if more primary-care providers embedded therapists into their practices, therapy could shed both its luxury status and its shame factor. It could become as ordinary and widespread as taking high-blood-pressure medications.
Bishop described a patient who came into the ETSU clinic recently and said, “I’m only here for my physicians’ assistant. There’s nothing you can do to help me.”
Bishop said, “You’re right, there’s nothing I can do to help you.”
That patient ended up coming to him for two years.
“Does everybody need psychotherapy? No,” Bishop said. “Could everyone benefit from psychotherapy? Probably.” Even Polaha once got therapy to overcome her public-speaking jitters—long after she’d already received her psychology doctorate.
With therapy so readily available, it might be hard for Bishop and Polaha’s patients to determine just how much therapy is enough—another struggle well-known to therapy-goers everywhere. Not unlike packing, therapy seems to take as much time as you have. Some studies show even one session of some types of therapy can help beat back depression, but the benefits of therapy tend to fizzle out as the number of sessions enters the double-digits. Bishop says a good therapist is a “mirror,” helping patients see their life goals more clearly, and reach them. Once you’ve achieved your goals, there’s little point in continuing.
I thought about my own therapy, which largely consists of me explaining the economic realities of journalism, over and over again, to a petite, middle-aged woman, after which she tells me to do more mindfulness exercises and charges me $170. “I wonder if I’ve been doing my therapy wrong,” I mused to Bishop during one quiet moment in the clinic.
“You’ve said that about four or five times in the last few days,” he said. “I think you should approach your therapist about that. I mean that sincerely.”
With his own patients, Bishop is sometimes the one who suggests it’s time to say goodbye. “I see myself working myself out of a job from day one,” he said.
At one point, it seemed like Bishop was trying to feel out whether one patient should still be coming to see him. She was a woman in her 50s, but she looked about 70, with a raspy voice and a tired expression, though she said she was feeling good. She had been seeing Bishop for years, talking about her struggle to quit smoking and a tessellating array of family issues. The woman spoke slowly and cautiously, in short sentences. At times, she sounded like she was answering a boring questionnaire rather than unburdening herself.
“Is it still helpful to meet?” Bishop asked finally.
“Yes,” she responded, to my surprise. She had been feeling more isolated from her friends than normal recently. “With me not being able to get to church, it’s nice to have a friend I can visit and talk with.”
Over the coming months, the woman did return to see Bishop several more times. But in the end, it was Bishop who announced he was moving on: He had accepted a new role at another university’s family-medicine center, where this coming year he will set up another integrated behavioral health practice. When Bishop offered to transfer her to a new therapist at ETSU, the woman declined. Even briskly efficient therapists, it seems, are too much like friends to be interchangeable.
Article source here:The Atlantic
0 notes